Refine
Year of publication
Document Type
- Conference Proceeding (14)
- Article (6)
- Book (2)
- Part of a Book (1)
Is part of the Bibliography
- yes (23)
Keywords
- Clinical handover (1)
- Common ground (1)
- Communication (1)
- Computerized patient records (1)
- Continuity of care (1)
- Electronic Health Record (1)
- Sign-out (1)
- cognition (1)
- continuity of care (1)
- information visualisation (1)
Institute
- Fakultät WiSo (23)
Patient handovers are cognitively demanding, crucial for information continuity and patient safety, but error prone. This study investigated the effect of an electronic handover tool, i.e. the handoverEHR, on the memory and care planning performance of nurse students (n=32) in a randomised, controlled cross-over design with the factors handover task and handover role. On a descriptive level, handover recipients could improve their memory performance with electronic support, handover givers their performance of writing care plans. Statistically meaningful differences occurred, however, only when the participants were givers. Without handover experience and with low fluency to word problems, givers performed badly in the most demanding of the handover tasks. Final recommendations, however, can only be made after replicating this study in a clinical setting with mixed groups.
Innovations are typically characterised by their relative newness for the user. In order for new eHealth applications to be accepted as innovations more criteria were proposed including “use” and “usability”. The handoverEHR is a new approach that allows the user to translate the essentials of a clinical case into a graphical representation, the so-called cognitive map of the patient. This study aimed at testing the software usability. A convenience sample of 23 experienced nurses from different healthcare organisations across the country rated the usability of the handoverEHR after performing typical handover tasks. All usability scales of the IsoMetricsL questionnaire showed positive values (4 “I agree”) with the exception of “error tolerance” (3 “neutral statement”). A significant improvement was found in self-descriptiveness as compared to an initial usability testing prior to this study. Different subgroups of users tended to rate the usability of the system differently. This study demonstrated the benefits of formative evaluations in terms of improving the usability of an entirely new approach. It thus helps to transform a novel piece of software towards becoming a real innovation. Our findings also hint at the importance of user characteristics that could affect the usability ratings.
Background: Clinical handovers at changes of shifts are typical scenarios of time restricted and information intensive communication, which are highly cognitively demanding. The currently available applications supporting handovers typically present complex information in a textual checklist-like manner. This presentation style has been criticised for not meeting the specific user requirements.
Objectives: We, therefore, aimed at developing a concept for visualising the overview of a clinical case that serves as an alternative way to checklist-like presentations in clinical handovers. We also aimed at implementing this concept in a handoverEHR in order to support the pre-handover phase, the actual handover, and the post-handover phase as well as at evaluating its usability and attractiveness.
Results: We developed and implemented a concept that draws on Tolman's pioneering work on cognitive maps that we designed in accordance with Gestalt principles. These maps provide a pictorial overview of a clinical case. The application to build, manipulate, and store the cognitive maps was integrated into an openEHR based handover record that extends conventional records with handover specific information. Usability (n = 28) and attractiveness (n = 26) testing with experienced clinicians resulted in good ratings for suitability for the task as well as for attractiveness and pragmatism.
Conclusion: We propose cognitive maps to represent and visualise the clinical case in situations where there is limited time to present complex information.
Handovers need a common ground on the clinical cases between the members of the successive shifts to establish continuity of care. Conventional electronic patient record systems (EHR) proved to be only insufficiently suitable for supporting the grounding process. Against this background we proposed a basic concept for a handover EHR that extends general EHRs in particular openEHR based systems. The resulting handover information model was implemented in a database and evaluated based on 120 clinical cases. The information items of these cases could be mapped successfully to the model, however, the new class “anticipatory guidance” needed to be introduced. The evaluation also demonstrated the importance of highly aggregated information on the clinical case, opinions and meta-information such as the relevance of an item during handovers. Based on these findings, in particular the handover database, handover EHR applications are currently developed to support the grounding process.