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UBC Theses and Dissertations

Patterns of action items in an electronic clinical handover tool Lo, Patrina


Background: Clinical handover is a complex process in which information and professional responsibility are transferred from one clinician to another. Communication gaps during clinical handover can contribute to medical errors, but structured clinical handover tools have been shown to reduce medical errors. Objectives: 1) Classify free-text action items from an electronic clinical handover tool into categories using an existing standard; 2) Understand patterns of action items in an electronic handover tool; and 3) Examine the relationship between categories of action items and patients’ acuity level. Method: This was a descriptive study in which one year of data from an electronic clinical handover tool were examined (July 1, 2015 to June 30, 2016). Free-text data were classified using continuity of care document categories from Health Level 7, and additional categories were created as needed. A chi-squared analysis was used to examine the relationship between number of action items per category and patients’ acuity levels. Results: Action items (n=3,444) were entered for 783 patients by 168 physicians. Most action items aligned with the continuity of care document categories (n=2949, 85.6%) and two additional categories were created, consults (n=431, 12.5%) and other (n=64, 1.9%). The most and least frequently documented categories were ‘results’, ‘consults’, and ‘plan of treatment,’ and ‘advanced care plan,’ ‘education,’ and ‘social history’ respectively. Most action items (n=3,039, 88%) had a documented acuity and were documented most frequently for patients with the stable acuity in the categories ‘results’, ‘consults’, and ‘plan of treatment’. A significant difference was found (X2=133.3, (df=36), p<0.001) with stable acuity (n=2381, 78.3%) being more likely to have action items entered than discharge acuity (n=30, 1%), watch acuity (n=581, 19.1%), or unstable acuity (n=47, 1.5%). Conclusion: Action items in the electronic clinical handover tool were found to align with the continuity of care document categories. Standardization within electronic clinical handover tools may reduce complexity by allowing for consistency in information documented during clinical handover, and interoperability between different electronic clinical handover tools. In the future, natural language processing could allow for automated classification of free-text action items.

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