Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses’ handoffs on medical and surgical units: Insights from interviews and observations
Abstract
Patient care handoffs are cognitively intense activities, especially on medical and surgical units where nurses synthesize information across an average of four to five patients every shift. The objective of this study was to examine handoffs and nurses' use of computerized patient summary reports in an electronic health record after computerized provider order entry (CPOE) was installed. We observed and audio taped 93 patient handoffs on 25 occasions on 5 acute care units in 2 different facilities sharing a vendor's electronic health record. We found that the computerized patient summary report and the electronic health record were minimally used during the handoff and that the existing patient summary reports did not provide adequate cognitive support for nurses. The patient summary reports were incomplete, rigid and did not offer "at a glance" information, or help nurses encode information. We make recommendations about a redesign of patient summary reports and technology to support the cognitive needs of nurses during handoffs at the change of shift.
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Existing EHR handoff summaries were too rigid and incomplete to be useful and interfered with the receiving nurse's encoding of information via note taking.
“Staggers et al31 found that existing EHR handoff summaries were too rigid and incomplete to be useful; additionally, they interfered with the receiving nurse's encoding of information via note taking.”
From Potential uses of AI for perioperative nursing handoffs: a qualitative study (2023) · cites this paper as [31]
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Human Factors and Outcomes in Pediatric Cardiac Surgery
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The Symbolic Functions of Nurses’ Cognitive Artifacts on a Medical Oncology Unit
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An Evidence-Based Evaluation of Medication Barcode Scanning Acceptance in a Community Hospital
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- Authors
- Staggers, N., Clark, L., Blaz, J. W., & Kapsandoy, S.
- Affiliations
- University of Maryland, Baltimore (US)
- University of Utah (US)
- Corresponding author
- Staggers, Nancy
- Venue
- Health Informatics Journal
- Publisher
- SAGE Publications
- Published
- 2011-09
- Volume
- 17
- Issue
- 3
- Pages
- 209-223
- ISSN
- 1355-4743 (ISSN-L)
- 1460-4582
- 1741-2811
- OpenAlex
- W2087047151
- Cited by
- 76
- References
- 54
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 5 · 2021: 5 · 2020: 4 · 2019: 11 · 2018: 9 · 2017: 2 · 2016: 6 · 2015: 3 · 2014: 9 · 2013: 10 · 2012: 5
- FWCI
- 8.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Informatics Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
- Keywords
- patient handover, electronic health records, cognitive support, nurses, computerized physician order entry, shift handover, medical-surgical units, information design, clinical decision support
- MeSH terms
- Academic Medical Centers, Adult, Attitude of Health Personnel, Cancer Care Facilities, Cognition, Continuity of Patient Care, Female, Forms and Records Control, Humans, Interprofessional Relations, Interviews as Topic, Male, Middle Aged, Nurses, Surgery Department, Hospital, Tape Recording, United States, Young Adult, Electronic Health Records
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