The unappreciated challenges of between-unit handoffs: negotiating and coordinating across boundaries

Annals of Emergency Medicine
Brian Hilligoss, Michael D Cohen

Abstract

Although interest in studying and improving handoffs has grown considerably in recent years, a general tendency to treat handoff as a single type of activity has resulted in overlooking important variation and in understudying one consequential type: between-unit handoffs. Using the admission handoff between emergency departments and inpatient services as an example, this conceptual article identifies 2 distinguishing structural features of between-unit transitions and demonstrate how these features create negotiation and coordination challenges that are further complicated by several contextual factors. Between-unit handoffs are distinguished from within-unit handoffs because the former are triggered by patient conditions as opposed to shift schedules and entail working across organizational boundaries rather than within them. Consequently, between-unit handoffs are challenged by several contextual factors, including interprofessional differences, unequal distributions of power among units, frequent lack of established relationships among the involved parties, infrequent face-to-face communication, a lack of awareness of the other unit's state, and the fact that responsibility and control of patients are transferred separately...Continue Reading

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May 15, 2013·International Emergency Nursing·Peter NugusJeffrey Braithwaite
Sep 11, 2012·Journal of the American Medical Informatics Association : JAMIA·Brian Hilligoss, Kai Zheng
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