Lawrence Renée H, Tomolo Anne M, Garlisi Andy P, Aron David C
Center for Quality Improvement and Research 14(W), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106, USA.
BMC Health Serv Res. 2008 Dec 16;8:256. doi: 10.1186/1472-6963-8-256.
The importance and complexity of handovers is well-established. Progress for intervening in the emergency department change of shift handovers may be hampered by lack of a conceptual framework. The objectives were to gain a better understanding of strategies used for change of shift handovers in an emergency care setting and to further expand current understanding and conceptualizations.
Observations, open-ended questions and interviews about handover strategies were collected at a Veteran's Health Administration Medical Center in the United States. All relevant staff in the emergency department was observed; 31 completed open-ended surveys; 10 completed in-depth interviews. The main variables of interest were strategies used for handovers at change of shift and obstacles to smooth handovers.
Of 21 previously identified strategies, 8 were used consistently, 4 were never used, and 9 were used occasionally. Our data support ten additional strategies. Four agent types and 6 phases of the process were identified via grounded theory analysis. Six general themes or clusters emerged covering factors that intersect to define the degree of handover smoothness.
Including phases and agents in conceptualizations of handovers can help target interventions to improve patient safety. The conceptual model also clarifies unique handover considerations for the emergency department setting.
交接班的重要性和复杂性已得到充分证实。缺乏概念框架可能会阻碍在急诊科交接班过程中进行干预的进展。目标是更好地了解在急诊护理环境中进行交接班时所使用的策略，并进一步拓展当前的理解和概念化认识。
在美国一家退伍军人健康管理局医疗中心收集了有关交接班策略的观察结果、开放式问题及访谈内容。观察了急诊科所有相关工作人员；31人完成了开放式调查；10人完成了深入访谈。主要关注的变量是交接班时所使用的策略以及顺利交接班的障碍。
在之前确定的21种策略中，8种被持续使用，4种从未被使用，9种偶尔被使用。我们的数据支持另外10种策略。通过扎根理论分析确定了4种主体类型和该过程的6个阶段。出现了6个一般主题或类别，涵盖了相互交叉以界定交接班顺利程度的因素。
在交接班的概念化过程中纳入阶段和主体有助于针对干预措施以提高患者安全。该概念模型还阐明了急诊科环境中独特的交接班注意事项。
