What can artefact analysis tell us about patient transitions between the hospital and primary care? Lessons from the HANDOVER project

Abstract

Background: Hospital discharge often faces breakdowns in information, communication, and coordination. The European Union FP7 Health Research Programme commissioned the European HANDOVER Project in 2008, a three year, 3.5 million Euro programme to examine transitions of patient care from the hospital to the community care settings. Six European countries—Italy, the Netherlands, Poland, United Kingdom, Spain, and Sweden—participated in this collaborative study.

Objectives: This paper highlights a multi-centre, multi-national research programme. We describe how HANDOVER participants conducted an ‘artefact analysis’ as one element of the mixed methods study to inform opportunities to make patient handovers between hospital and community care more effective.

Methods: The artefact analysis consisted of a four-step process to assess different tools used in communication and treatment and their effects on the communication processes between the hospital and general practice settings.

Results: Four themes emerged from our analysis: (a) The inpatient care of a patient is ‘hospital centric’ whereby the hospital ‘pulls’ information regarding a patient's family physician (b) There are rich cognitive artefacts that support the patient clinician encounter; c) The use of information technology does not necessarily improve the communication process; and (d) There is a role for the patient, albeit not particularly well-defined or explicit, as a conduit for essential information communication.

Conclusion: Cognitive artefact analysis is an innovative method to provide insights into transitions of patient care. It may be most useful to think about interventions at both the individual patient and the system levels that more fully address and overcome the system issues at work.

Keywords::

• patient safety
• transitions of care
• handovers
• cognitive artefacts
• artefact analysis

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding/support. The authors wish to acknowledge the two funding sources for these studies. The US study was supported by the Agency for Healthcare Research and Quality (AHRQ), 1 P20 HS017119 A model for effective communications for inpatient ambulatory transitions; the European study was supported by a grant from the European Union, the 7th Framework Programme of the European Commission (FP7-HEALTH-F2-2008-223409). The study sponsors had no role in the study design, collection, analysis, interpretation of the data, or any other contribution.