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Research objective 1

To identify the barriers and facilitators to effective handover in the social, linguistic and technological contexts in which they take place in different European settings

In order to identify standardized basic elements and best practices in handover processes, research about how handovers actually take place and the contextual, linguistic and technological barriers and facilitators that characterize them will be necessary. As regional and/or cultural differences can be expected in Europe these should be taken into account in the execution of the research. Existing data provides an inconclusive picture how handoffs are dealt with in different European situations.
We will begin by an extensive literature search followed by a multi-method study to  capture the handoffs occurring between several microsystems (e.g. primary care  physicians, nurses, ED personnel and other) providing care following a handoff in different European settings. The data will be triangulated with critical incident interviews from patients and practitioners and system safety re-ports to create an in-depth picture of handoff-related activities that lead to a range of outcomes rang-ing from adverse events to “near misses” to less serious deviations from intended care processes. A major outcome of the research will be a deeper understanding of variations in communication, con-text, and technology use in nursing and medicine that lead to effective or suboptimal handoffs.
We will conduct individual interviews using the critical incident and appreciative inquiry techniques to identify near miss/adverse events with representatives from key stakeholder groups (primary care physicians, nurses, hospital care teams, graduate residents in training (i.e., internal medicine, surgery, pediatrics), and patients or their families). In addition, focus groups will be conducted with each key stake-holder group. We will develop process maps to define the perceptions of the current process and satisfaction with the process. We will conduct an artifact analysis of the documents that demonstrate evidence of communication between inpatient physicians and primary care physicians during the in-patient-ambulatory transition.