Use of simulated physician handoffs to study cross-cover chart biopsy in the electronic medical record

Clinical handoffs involve the rapid transfer of patient information from one provider or team to another, through activities which may introduce errors and affect care delivery. "Cross-coverage" requires quickly familiarizing oneself with unfamiliar patients whose management plans were established by another provider or team. Through this work, we describe physicians' information seeking approaches within an electronic medical record (EMR) during physician handoff and chart biopsy at a major academic medical center. We conducted simulated handoff sessions and interviews with 21 physicians using standardized patient cases and we analyzed screen capture data, and video and audio recordings of interactions with the EMR and handoff printouts. We found highly variable navigation of the EMR but greater similarity in physicians' EMR navigation behavior when the chart review was prompted by simulated interruptions. Understanding how physicians seek and assimilate patient data can inform handoff tool design and suggest strategies for explicitly supporting EMR chart biopsies

Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review

<p>Unresolved conflicts among healthcare professionals can lead to difficult patient care consequences. This scoping review examines the current healthcare literature that reported sources and consequences of conflict associated with individual, interpersonal, and organisational factors. We identified 99 articles published between 2001 and 2015 from PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medical Database. Most reviewed studies relied on healthcare professionals’ perceptions and beliefs associated with conflict sources and consequences, with few studies reporting behavioural or organisational change outcomes. Individual conflict sources included personal traits, such as self-focus, self-esteem, or worldview, as well as individuals’ conflict management styles. These conflicts posed threats to one’s physical, mental, and emotional health and to one’s ability to perform at work. Interpersonal dynamics were hampered by colleagues’ uncivil behaviours, such as low degree of support, to more destructive behaviours including bullying or humiliation. Perceptions of disrespectful working environment and weakened team collaboration were the main interpersonal conflict consequences. Organisational conflict sources included ambiguity in professional roles, scope of practice, reporting structure, or workflows, negatively affecting healthcare professionals’ job satisfactions and intent to stay. Future inquiries into healthcare conflict research may target the following: shifting from research involving single professions to multiple professions; dissemination of studies via journals that promote interprofessional research; inquiries into the roles of unconscious or implicit bias, or psychological capital (i.e., resilience) in healthcare conflict; and diversification of data sources to include hospital or clinic data with implications for conflict sources.</p