Information Content Across Types of Nurse Cognitive Artifacts.

Acute care nurses commonly use personalized cognitive artifacts to organize information during a shift. The purpose of this content analysis is to compare information content across three formats of cognitive artifacts used by acute care nurses in a medical oncology unit: hand-made free-form, preprinted skeleton, and EHR-generated. Information contained in free-form and skeleton artifacts is more tailored to specific patient context than the NSR. Free-form and skeleton artifacts provide a space for synthesizing information to construct a "story of the patient" that is missing in the NSR. Future design of standardized handoff tools will need to take these differences into account for successful adoption by acute care nurses, including tailoring of information by patient, not just unit type, and allowing a space for nurses to construct a narrative describing the patients "story."

Patient-centered handovers between hospital and primary health care: an assessment of medical records.

BACKGROUND: Handovers between hospital and primary healthcare possess a risk for patient care. It has been suggested that the exchange of a comprehensive medical record containing both medical and patient-centered aspects of information can support high quality handovers. OBJECTIVE: The objective of this study was to explore patient handovers between primary and secondary care by assessing the levels of patient-centeredness of medical records used for communication between care settings and by assessing continuity of patient care. METHODS: Quantitative content analysis was used to analyze the 76 medical records of 22 Swedish patients with chronic diseases and/or polypharmacy. RESULTS: The levels of patient-centeredness documented in handover records were assessed as poor, especially in regards to informing patients and achieving a shared understanding/agreement about their treatment plans. The follow up of patients' medical and care needs were remotely related to the discharge information sent from the hospital to the primary care providers, or to the hospital provider's request for patient follow-up in primary healthcare. CONCLUSION: The lack of patient-centered documentation either indicates poor patient-centeredness in the encounters or low priority given by the providers on documenting such information. Based on this small study, discharge information sent to primary healthcare cannot be considered as a means of securing continuity of patient care. Healthcare providers need to be aware that neither their discharge notes nor their referrals will guarantee continuity of patient care.