Discipline-Based Communication Differences Between Clinicians in Operating Room to Intensive Care Unit Handoffs




Associate Professor of Anesthesiology and Critical Care & Epidemiology

Project Summary

Surgical patients who require post-surgical critical care are transferred from the operating room (OR) to the intensive care unit (ICU) for ongoing care. The process of transferring the patient from the OR to the ICU is called a “handoff.” Handoffs involve the transfer of patient care responsibilities and transfer of patient information from the OR team to the ICU team. Four clinicians (surgeon, anesthetist, ICU provider, and ICU nurse) take part in handoff communication.

The purpose of this study is to understand how clinicians’ training backgrounds affect the ways in which the clinicians approach the handoff encounter. Evaluating differences in clinician communication in OR to ICU handoffs on the basis of training background will allow for a better understanding of how observed adaptations and variations of handoff processes arise. Further, identification of discipline-based communication differences will enable the development and refinement of handoff procedures and handoff education practices that are tailored to clinicians’ professional backgrounds and are better able to meet clinicians’ needs.  Therefore, this study has the potential to optimize handoff procedures and accordingly minimize preventable healthcare-related harm to patients.

Study data is derived from surveys, observations, and one on one interviews. Surveys are distributed to gauge clinicians’ handoff training, approaches, and preferences. The surveys are supplemented by observations of OR to ICU handoffs in the surgical intensive care unit at the Hospital of the University of Pennsylvania to analyze the actions of clinicians from different training backgrounds. Interviews with clinicians involved in OR to ICU handoff communication will then be conducted to understand the thought processes, perspectives, actions, and attitudes that lead the clinicians to approach OR to ICU handoffs in discipline-specific or universal ways.  This study has high impact because it can yield vital data needed to optimize handoff procedures and handoff education practices.

Through my research experience, I have gained insights into the design, development, and execution of qualitative and quantitative techniques in health services research. I learned how to create a survey with neutrally worded questions and how to best administer the survey to achieve a sufficient response rate in a healthcare setting. I also learned to devise an observation assessment template and rubric to guide qualitative recordings of the handoff encounter. Additionally, I learned to write interview questions that would effectively prompt interviewees and probe them for deeper insights without leading interviewees towards predetermined responses.

By working on this project, I have honed my abilities in health services research and have cultivated my interest in the improvement of patient care and safety. I plan to attend medical school after completing my undergraduate studies, and the skills that I have developed through this project will benefit me in my research during medical school and throughout my career as a physician.