Electronic Tools for Cognitive Support During Resident Handoffs: State of the Practice and Future Directions

In the years following reduced resident work hours, single resident accountability for patient care has disappeared and replaced by frequent care transitions and shared responsibility between residents as the necessary paradigm for delivery of care in acute care settings. With this change, there has been increasing patient acuity and complexity as well as increased cognitive demands for clinicians, potential for miscommunication at care transitions, and preventable errors. Importantly, forgetting to transmit needed information during handoffs is a major contribution to overall suboptimal care processes including: delays in diagnosis and treatment, task omissions, work redundancies and near misses. To address these quality and safety problems, electronic tools embedded in the electronic health record are beginning to emerge. These tools when designed to provide cognitive support for intradisciplinary sharing of care can play a role in reducing information overload, miscommunication, and omission of patient care tasks. Less common are electronic tools that are designed for interdisciplinary information sharing. These interdisciplinary tools have greater potential for decreasing system inefficiencies and improving the overall quality of care delivery than intra-disciplinary tools. This presentation will provide an overview of existing electronic handoff tools and the design implications for future tools.