Vidyarthi Arpana R, Arora Vineet, Schnipper Jeffrey L, Wall Susan D, Wachter Robert M
Department of Medicine, University of California, San Francisco, CA, USA.
J Hosp Med. 2006 Jul;1(4):257-66. doi: 10.1002/jhm.103.
Restrictions in the hours residents can be on duty have resulted in increased sign-outs, that is, transfer of patient care information and responsibility from one physician to a cross-coverage physician, leading to discontinuity in patient care. This sign-out process, which occurs primarily in the inpatient setting, traditionally has been informal, unstructured, and idiosyncratic. Although studies show that discontinuity may be harmful to patients, this is little data to assist residency programs in redesigning systems to improve sign-out and manage the discontinuity.
This article reviews the relevant medical literature, current practices in non-health professions in managing discontinuity, and summarizes the existing practice and experiences at 3 academic internal medicine hospitalist-based programs.
We provide recommendations and strategies for best practices to design safe and effective sign-out systems for residents that may also be useful to hospitalists working in academic and community settings.
对住院医师值班时长的限制导致了交接班次数的增加，即患者护理信息及责任从一名医师转移至负责交叉值班的医师，从而造成患者护理的不连续性。这一交接班过程主要发生在住院环境中，传统上一直是非正式、无组织且因人而异的。尽管研究表明护理的不连续性可能对患者有害，但几乎没有数据可帮助住院医师培训项目重新设计系统以改善交接班并处理护理的不连续性。
本文回顾了相关医学文献、非医疗行业管理工作交接的现行做法，并总结了3个以学术内科住院医师为主的项目的现有做法及经验。
我们为设计安全有效的住院医师交接班系统的最佳实践提供了建议和策略，这些建议和策略可能对在学术和社区环境中工作的住院医师也有用。
