Using Epistemic Network Analysis to Explore Outcomes of Care Transitions

  • Abigail R. WooldridgeEmail author
  • RuthAnn Haefli
Conference paper
Part of the Communications in Computer and Information Science book series (CCIS, volume 1112)


Care transitions are important to patient safety, but we lack consensus on what outcomes of transitions to evaluate. We interviewed 28 physicians and nurses who participate in transitions of adult and pediatric trauma patients from the operating room to the intensive care unit. The handoff (i.e., communication about patient information) in the pediatric care transition was done together as a team while the other handoff was separated by profession. In this study, we identify nine care transition outcomes: (1) communication sufficiency, completeness and accuracy, (2) handoff timing, (3) patient outcomes, (4) change in workload, (5) individual situation awareness, (6) team situation awareness, (7) organization awareness, (8) team experience and (9) timing of feedback. These outcomes could be positive and negative (i.e., good or bad). This study also investigates relationships between outcomes in the two groups using epistemic network analysis (ENA). While we found the no difference between the outcomes in the team and separate handoff when comparing frequency counts, relationships between outcomes did differ when using ENA. Interviewees with the team handoff described more relationships between care team level outcomes – team situation awareness and team experience – and other outcomes, while interviewees with the separate handoffs focused on the relationship between communication and patient outcome. Future work should investigate differences in relationships between positive and negative valences of the outcomes.


Care transition outcomes Handoffs Epistemic network analysis 



Funding for this research was provided by the Agency for Healthcare Research and Quality (AHRQ) [Grant No. R01-HS023837] (PI: Ayse P. Gurses, Johns Hopkins University; PI of UW-Madison subcontract: Pascale Carayon) and the Research Experience for Undergraduates program of the Department of Industrial and Enterprise Systems Engineering at the University of Illinois at Urbana-Champaign. This work was funded in part by the National Science Foundation (DRL-1661036, DRL-1713110), the Wisconsin Alumni Research Foundation, and the Office of the Vice Chancellor for Research and Graduate Education at the University of Wisconsin-Madison. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. We thank the study participants, as our research would not be possible without them.


  1. 1.
    Abraham, J., Kannampallil, T., Patel, V.L.: A systematic review of the literature on the evaluation of handoff tools: implications for research and practice. J. Am. Med. Inform. Assoc.: JAMIA 21(1), 154–162 (2014)CrossRefGoogle Scholar
  2. 2.
    Perry, S.J.: Transitions in care: studying safety in emergency department signovers. Focus Patient Saf. 7(2), 1–3 (2004)Google Scholar
  3. 3.
    Arora, V.M., Manjarrez, E., Dressler, D.D., Basaviah, P., Halasyamani, L., Kripalani, S.: Hospitalist handoffs: a systematic review and task force recommendations. J. Hosp. Med. 4(7), 433–440 (2009)CrossRefGoogle Scholar
  4. 4.
    The Joint Commission: Inadequate hand-off communication. Sentinel Event Alert 58, 1–6 (2017)Google Scholar
  5. 5.
    Abraham, J., Ihianle, I., Burton, S.: Exploring information seeking behaviors in inter-unit clinician handoffs. In: International Symposium on Human Factors and Ergonomics in Health Care, pp. 226–231. SAGE Publications Sage India, New Delhi, India (2017)CrossRefGoogle Scholar
  6. 6.
    Robertson, E.R., Morgan, L., Bird, S., Catchpole, K., McCulloch, P.: Interventions employed to improve intrahospital handover: a systematic review. BMJ Qual. Saf. 23(7), 600–607 (2014)CrossRefGoogle Scholar
  7. 7.
    Shaffer, D.W.: Quantitative Ethnography. Madison, Indianapolis (2017)Google Scholar
  8. 8.
    Daniellou, F.: The French-speaking ergonomists’ approach to work activity: cross-influences of field intervention and conceptual models. Theor. Issues Ergon. Sci. 6(5), 409–427 (2005)CrossRefGoogle Scholar
  9. 9.
    Wooldridge, A.R., et al.: Complexity of the pediatric trauma care process: implications for multi-level awareness. Cogn. Technol. Work 21, 397–416 (2018)CrossRefGoogle Scholar
  10. 10.
    Wooldridge, A.R., et al.: Work System Barriers and Facilitators in Inpatient Care Transitions of Pediatric Trauma Patients (Submitted)Google Scholar
  11. 11.
    Wooldridge, A.R.: Team Cognition Distributed in Spatio-Temporal Processes: A Macroergonomic Approach to Trauma Care. ProQuest, University of Wisconsin, Madison (2018)Google Scholar
  12. 12.
    Injury Prevention and Control: Data & Statistics (WISQARS) (2015). Accessed 28 Feb 2019
  13. 13.
    Wooldridge, A.R., Carayon, P., Hundt, A.S., Hoonakker, P.L.T.: SEIPS-based process modeling in primary care. Appl. Ergon. 60, 240–254 (2017)CrossRefGoogle Scholar
  14. 14.
    Swiecki, Z., Ruis, A.R., Farrell, C., Shaffer, D.W.: Assessing individual contributions to collaborative problem solving: a network analysis approach. Comput. Hum. Behav. (2019)Google Scholar
  15. 15.
    Robson, C.: Real World Research, 3rd edn. Wiley, Chincester (2011)Google Scholar
  16. 16.
    Devers, K.J.: How will we know “good” qualitative research when we see it? Beginning the dialogue in health services research. Health Serv. Res. 34(5), 1153–1188 (1999)Google Scholar
  17. 17.
    Marquart, C.L., Hinojosa, C., Swiecki, Z., Eagan, B., Shaffer, D.W.: Epistemic Network Analysis (Version 1.5.2) (2018). 1.5.2 edGoogle Scholar
  18. 18.
    Shaffer, D.W., Collier, W., Ruis, A.R.: A tutorial on epistemic network analysis: analyzing the structure of connections in cognitive, social, and interaction data. J. Learn. Anal. 3(3), 9–45 (2016)CrossRefGoogle Scholar
  19. 19.
    Lingard, L., et al.: Communication failures in the operating room: an observational classification of recurrent types and effects. BMJ Qual. Saf. 13(5), 330–334 (2004)CrossRefGoogle Scholar
  20. 20.
    Endsley, M.R.: Toward a theory of situation awareness in dynamic systems. Hum. Factors: J. Hum. Factors Ergon. Soc. 37(1), 32–64 (1995)CrossRefGoogle Scholar
  21. 21.
    Schultz, K., Carayon, P., Hundt, A.S., Springman, S.R.: Care transitions in the outpatient surgery preoperative process: facilitators and obstacles to information flow and their consequences. Cogn. Technol. Work 9(4), 219–231 (2007)CrossRefGoogle Scholar
  22. 22.
    Endsley, M.R.: Proceedings of the National Aerospace and Electronics Conference. IEEE, New York (1988)Google Scholar
  23. 23.
    Prince, C., Salas, E.: Team situation awareness, errors, and crew resource management: research integration for training guidance. In: Situation Awareness Analysis and Measurement, pp. 325–347 (2000)Google Scholar
  24. 24.
    Endsley, M.R., Jones, W.M.: Situation Awareness Information Dominance & Information Warfare (1997)Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Illinois at Urbana-ChampaignUrbanaUSA

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