Potential uses of AI for perioperative nursing handoffs: a qualitative study.

Objective: Situational awareness and anticipatory guidance for nurses receiving a patient after surgery are key to patient safety. Little work has defined the role of artificial intelligence (AI) to support these functions during nursing handoff communication or patient assessment. We used interviews and direct observations to better understand how AI could work in this context. Materials and Methods: 58 handoffs were observed of patients entering and leaving the post-anesthesia care unit at a single center. 11 nurses participated in semi-structured interviews. Mixed inductive-deductive thematic analysis extracted major themes and subthemes around roles for AI supporting postoperative nursing. Results: Four themes emerged from the interviews: (1) Nurse understanding of patient condition guides care decisions, (2) Handoffs are important to nurse situational awareness; problem focus and information transfer may be improved by AI, (3) AI may augment nurse care decision making and team communication, (4) User experience and information overload are likely barriers to using AI. Key subthemes included that AI-identified problems would be discussed at handoff and team communications, that AI-estimated elevated risks would trigger patient re-evaluation, and that AI-identified important data may be a valuable addition to nursing assessment. Discussion and Conclusion: Most research on postoperative handoff communication relies on structured checklists. Our results suggest that properly designed AI tools might facilitate postoperative handoff communication for nurses by identifying elevated risks faced by a specific patient, triggering discussion on those topics.

A Topic Modeling Analysis of Nursing Handoff Studies

This study used topic modeling to analyse key topics of nursing handoff research. Six topics were identified. The findings indicate that future studies should implement the standardization of handoff tools and the use of bedside handoff, and evaluate their effects on patient safety outcomes.

‘This is our liver patient…’: use of narratives during resident and nurse handoff conversations

ObjectiveHandoffs are often framed as the co-construction of a shared understanding relying on narrative storytelling. We investigated how narratives are constructed and used during resident and nurse handoff conversations.MethodWe audio-recorded resident (n=149) and nurse (n=126) handoffs in an inpatient medicine unit. Qualitative analysis using grounded theory was conducted to identify and characterise the structure of resident and nursing handoff narratives.ResultsHandoff conversations among both residents and nurses used three types of narratives: narratives on creating clinical imagery, narratives on coordinating care continuity and narratives on integrating contextual aspects of care. Clinical imagery narratives were common during patient introductions: residents used a top-down approach relying on overarching patient clinical situations (eg, ‘a liver patient’), whereas nurses used a bottom-up approach using patient-specific identifying information. Narratives on the coordination of care continuity for residents focused on managing internal and external coordination activities, whereas nurse narratives focused on internal coordination, emphasising their role as an interface between patients and their physicians. Both resident and nurse narratives on the contextual aspects of care had considerable focus on highlighting ‘heads up’ anticipatory information and personal patient information; such information was often not present in patient charts, but was important for ensuring effective care management.DiscussionThe presence of narrative structures highlights the need for new perspectives for the design of handoff tools that allow for both informational and cognitive support and shared awareness among conversational partners during handoff conversations. We discuss the implications of the use of narratives for patient safety and describe specific design considerations for supporting narrative interactions during handoffs.

Priming Patient Safety Through Nursing Handoff Communication: A Simulation Pilot Study

Understanding how safety culture mechanisms affect nursing safety-oriented behavior and thus patient outcomes is critical to developing hospital safety programs. Safety priming refers to communicating safety values intended to activate patient safety goals. Safety priming through nursing handoff communication was tested as a means by which cultural safety values may affect nursing practice. The mixed-methods pilot study setting was an academic medical center’s high-fidelity simulation lab. Twenty nurses were randomized into intervention and control groups. The intervention group received a safety priming intervention; all participants were observed for completing appropriate actions in response to patient safety risks embedded in a scenario. Stimulated recall interviews were conducted following simulation completion. Nurses receiving the safety priming intervention performed slightly but non-significantly more safety actions than nurses who did not (60.5% vs. 57.9% of 43 actions). Implications for both research and practice are discussed for interventions targeting routine versus safety goal-directed nursing actions.