Care transition of trauma patients: Processes with articulation work before and after handoff

Abigail R. Wooldridge, Pascale Carayon, Peter Hoonakker, Bat Zion Hose, Katherine Schroeer, Tom Brazelton, Ben Eithun, Deborah Rusy, Joshua Ross, Jonathan Kohler, Michelle M. Kelly, Shannon Dean, Scott Springman, Rima Rahal, Ayse P. Gurses

Research output: Contribution to journalArticlepeer-review


While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork. Care transitions are complex, spatio-temporal processes and involve work during the transition (i.e., handoff and transport) and preparation and follow up activities (i.e., articulation work). Physicians defined the transition as starting earlier and ending later than nurses. Clinicians in the OR to adult ICU transition without a team handoff reported significantly less information loss and better cooperation, despite positive interview data. A team handoff and supporting articulation work should increase awareness, improving quality and safety of care transitions.

Original languageEnglish (US)
Article number103606
JournalApplied Ergonomics
StatePublished - Jan 2022


  • Care transition
  • Communication and coordination
  • Process mapping

ASJC Scopus subject areas

  • Human Factors and Ergonomics
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Safety, Risk, Reliability and Quality
  • Engineering (miscellaneous)


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