Borowitz S M, Waggoner-Fountain L A, Bass E J, Sledd R M
Division of Pediatric Gastroenterology and Nutrition, University of Virginia, Charlottesville, Virginia 22908, USA.
Qual Saf Health Care. 2008 Feb;17(1):6-10. doi: 10.1136/qshc.2006.019273.
During sign-out (handover of care), information and responsibility about patients is transferred from one set of caregivers to another. Few residency training programmes formally teach resident physicians how to sign out or assess their ability to sign out, and little research has examined the sign-out process.
To characterise the effectiveness of the sign-out process between resident physicians on an acute care ward. Design/
Resident physicians rotating on a paediatric acute care ward participated in a prospective study. Immediately after an on-call night, they completed a confidential survey characterising their night on call, the adequacy of the sign-out they received, and where they went to get information they had not received during sign-out.
158 of 196 (81%) potential surveys were collected. On 49/158 surveys (31%), residents indicated something happened while on call they were not adequately prepared for. In 40/49 instances residents did not receive information during sign-out that would have been helpful, and in 33/40 the situation could have been anticipated and discussed during sign-out. The quality of sign-out (assessed using a five-point Likert scale from 1 = inadequate to answer call questions to 5 = adequate to answer call questions) on the nights when something happened the resident was not adequately prepared for were significantly different than the nights they felt adequately prepared (mean (SD) score 3.58 (0.92) and 4.48 (0.70); p = 0.001). There were no significant differences in: how busy the nights were; numbers of patients on service at the beginning of the call shift; numbers of admissions during a call shift; numbers of transfers to an intensive care unit; whether residents were "cross-covering" or were members of the general ward team; or whether the resident had cared for the patient previously.
Although sign-out between resident physicians is a frequent activity, there are many times when important information is not transmitted. Analysis of these "missed opportunities" can be used to help develop an educational programme for resident physicians on how to sign out more effectively.
在交接班（护理工作交接）期间，患者的信息和责任从一组护理人员转移至另一组。很少有住院医师培训项目会正式教授住院医师如何进行交接班或评估他们的交接班能力，并且几乎没有研究对交接班过程进行过考察。
描述急症病房住院医师之间交接班过程的有效性。设计/
在儿科急症病房轮转的住院医师参与了一项前瞻性研究。在值完一个夜班后，他们立即完成了一项保密调查，描述他们的夜班情况、所接收交接班信息的充分性，以及他们从何处获取在交接班期间未收到的信息。
共收集到196份潜在调查问卷中的158份（81%）。在158份调查问卷中的49份（31%）上，住院医师表示在值班期间发生了一些他们未充分准备的事情。在49例中的40例情况下，住院医师在交接班时未收到本会有所帮助的信息，并且在40例中的33例中，这种情况在交接班时本可被预见并进行讨论。在住院医师对发生的事情未充分准备的那些夜晚，交接班的质量（使用从1 = 不足以回答呼叫问题到5 = 足以回答呼叫问题的五点李克特量表进行评估）与他们感觉准备充分的夜晚相比有显著差异（均值（标准差）得分分别为3.58（0.92）和4.48（0.70）；p = 0.001）。在以下方面没有显著差异：夜晚的繁忙程度；呼叫班次开始时病房内的患者数量；呼叫班次期间的入院人数；转入重症监护病房的人数；住院医师是“交叉值班”还是普通病房团队的成员；或者住院医师之前是否护理过该患者。
虽然住院医师之间的交接班是一项频繁的活动，但很多时候重要信息并未传递。对这些“错失的机会”进行分析可用于帮助为住院医师制定关于如何更有效进行交接班的教育项目。
