Discourse and process analyses of shift change handoffs in emergency departments

The need for 24 x 7 x 365 service in emergency departments (EDs) requires physicians and other health professionals to work in temporally delimited shifts. Handoffs between on-coming and off-going workers at shift changes are used to bridge gaps in care and to prepare the on-coming party to assume the ongoing work of care safely and effectively. We audio-recorded shift change conversations at 4 North American EDs and analysed them using a conversational framework. We compare these conversations among ED workers to reports of similar handoff conversations occurring between ED physicians and hospitalist at the time of patient admission. We found receiving parties in ED shift changes to be more active in the elicitation of information, rather than being passive recipients of information. This suggests that a co-construction or distributed cognition framing of handoffs may be more useful in understanding and improving handoffs than the information transfer framing commonly assumed by medically oriented researchers, at least in this setting.