Department of Trauma and Orthopaedics, University College Hospital, London NW1 2PG, United Kingdom.
Injury. 2009 Apr;40(4):388-96. doi: 10.1016/j.injury.2008.10.006. Epub 2009 Feb 13.
Continuity of patient care is an essential prerequisite for the successful running of a trauma surgery service. This is becoming increasingly difficult because of the new working arrangements of junior doctors. Handover is now central to ensure continuity of care following shift change over. The purpose of this study was to compare the quality of information handed over using the traditional ad hoc method of a handover sheet versus a web-based electronic software programme. It was hoped that through improved quality of handover the new system would have a positive impact on clinical care, risk and time management.
Data was prospectively collected and analyzed using the SPSS 14 statistical package. The handover data of 350 patients using a paper-based system was compared to the data of 357 cases using the web-based system. Key data included basic demographic data, responsible surgeon, location of patient, injury site including site, whether fractures were open or closed, concomitant injuries and the treatment plan. A survey was conducted amongst health care providers to assess the impact of the new software.
With the introduction of the electronic handover system, patients with missing demographic data reduced from 35.1% to 0.8% (p<0.0001) and missing patient location from 18.6% to 3.6% (p<0.0001). Missing consultant information and missing diagnosis dropped from 12.9% to 2.0% (p<0.0001) and from 11.7% to 0.8% (p<0.0001), respectively. The missing information regarding side and anatomical site of the injury was reduced from 31.4% to 0.8% (p<0.0001) and from 13.7% to 1.1% (p<0.0001), respectively. In 96.6% of paper ad hoc handovers it was not stated whether the injury was 'closed' or 'open', whereas in the electronic group this information was evident in all 357 patients (p<0.0001). A treatment plan was included only in 52.3% of paper handovers compared to 94.7% (p<0.0001) of electronic handovers. A survey revealed 96% of members of the trauma team felt an improvement of handover since the introduction of the software, and 94% of members were satisfied with the software.
The findings of our study show that the use of web-based electronic software is effective in facilitating and improving the quality of information passed during handover. Structured software also aids in improving work flow amongst the trauma team. We argue that an improvement in the quality of handover is an improvement in clinical practice.
患者护理的连续性是创伤外科服务成功运行的基本前提。由于初级医生的新工作安排，这变得越来越困难。交接班现在是确保班次变更后护理连续性的核心。本研究旨在比较使用传统的临时交接表和基于网络的电子软件程序交接信息的质量。希望通过提高交接质量，新系统能够对临床护理、风险和时间管理产生积极影响。
使用 SPSS 14 统计软件包前瞻性收集和分析数据。将使用纸质系统的 350 名患者的交接数据与使用基于网络的系统的 357 例患者的数据进行比较。关键数据包括基本人口统计学数据、主治医生、患者位置、损伤部位（包括部位）、骨折是否为开放性或闭合性、伴随损伤和治疗计划。对医疗保健提供者进行了一项调查，以评估新软件的影响。
引入电子交接系统后，缺失人口统计学数据的患者从 35.1%降至 0.8%（p<0.0001），缺失患者位置的患者从 18.6%降至 3.6%（p<0.0001）。缺失顾问信息和缺失诊断的比例分别从 12.9%降至 2.0%（p<0.0001）和从 11.7%降至 0.8%（p<0.0001）。缺失的关于损伤侧和解剖部位的信息从 31.4%降至 0.8%（p<0.0001）和从 13.7%降至 1.1%（p<0.0001）。在 96.6%的纸质临时交接中，没有说明损伤是“闭合性”还是“开放性”，而在电子组中，所有 357 名患者均有此信息（p<0.0001）。仅在 52.3%的纸质交接中包含治疗计划，而在电子交接中则为 94.7%（p<0.0001）。一项调查显示，创伤团队的 96%成员表示自软件引入以来交接质量有所提高，94%的成员对软件感到满意。
我们的研究结果表明，使用基于网络的电子软件可有效促进和提高交接过程中传递的信息质量。结构化软件还有助于改善创伤团队的工作流程。我们认为，交接质量的提高就是临床实践的改进。
