Using Epistemic Network Analysis to Explore Outcomes of Care Transitions

Abstract

Care transitions are important to patient safety, but we lack consensus on what outcomes of transitions to evaluate. We interviewed 28 physicians and nurses who participate in transitions of adult and pediatric trauma patients from the operating room to the intensive care unit. The handoff (i.e., communication about patient information) in the pediatric care transition was done together as a team while the other handoff was separated by profession. In this study, we identify nine care transition outcomes: (1) communication sufficiency, completeness and accuracy, (2) handoff timing, (3) patient outcomes, (4) change in workload, (5) individual situation awareness, (6) team situation awareness, (7) organization awareness, (8) team experience and (9) timing of feedback. These outcomes could be positive and negative (i.e., good or bad). This study also investigates relationships between outcomes in the two groups using epistemic network analysis (ENA). While we found the no difference between the outcomes in the team and separate handoff when comparing frequency counts, relationships between outcomes did differ when using ENA. Interviewees with the team handoff described more relationships between care team level outcomes – team situation awareness and team experience – and other outcomes, while interviewees with the separate handoffs focused on the relationship between communication and patient outcome. Future work should investigate differences in relationships between positive and negative valences of the outcomes.