Riesenberg Lee Ann, Leitzsch Jessica, Massucci Jaime L, Jaeger Joseph, Rosenfeld Joel C, Patow Carl, Padmore Jamie S, Karpovich Kelly P
Christiana Care Health System, Newark, Delaware 19718, USA.
Acad Med. 2009 Dec;84(12):1775-87. doi: 10.1097/ACM.0b013e3181bf51a6.
Effective communication is central to patient safety. There is abundant evidence of negative consequences of poor communication and inadequate handoffs. The purpose of the current study was to conduct a systematic review of articles focused on physicians' handoffs, conduct a qualitative review of barriers and strategies, and identify features of structured handoffs that have been effective.
The authors conducted a thorough, systematic review of English-language articles, indexed in PubMed, published between 1987 and June 2008, and focused on physicians' handoffs in the United States. The search strategy yielded 2,590 articles. After title review, 401 were obtained for further review by trained abstractors.
Forty-six articles met inclusion criteria, 33 (71.7%) of which were published between 2005 and 2008. Content analysis yielded 91 handoffs barriers in eight major categories and 140 handoffs strategies in seven major categories. Eighteen articles involved research on handoffs. Quality assessment scores for research studies ranged from 1 to 13 (possible range 1-16). One third of the reviewed research studies obtained quality scores at or below 8, and only one achieved a score of 13. Only six studies included any measure of handoff effectiveness.
Despite the negative consequences of inadequate physicians' handoffs, very little research has been done to identify best practices. Many of the existing peer-reviewed studies had design or reporting flaws. There is remarkable consistency in the anecdotally suggested strategies; however, there remains a paucity of evidence to support these strategies. Overall, there is a great need for high-quality handoff outcomes studies focused on systems factors, human performance, and the effectiveness of structured protocols and interventions.
有效的沟通是患者安全的核心。有大量证据表明沟通不畅和交接班不充分会产生负面后果。本研究的目的是对关注医生交接班的文章进行系统综述，对障碍和策略进行定性综述，并确定有效的结构化交接班的特征。
作者对1987年至2008年6月期间发表在PubMed上的英文文章进行了全面、系统的综述，这些文章聚焦于美国医生的交接班。检索策略共获得2590篇文章。经过标题筛选，401篇文章被交给训练有素的摘要撰写人员进行进一步审查。
46篇文章符合纳入标准，其中33篇（71.7%）发表于2005年至2008年之间。内容分析得出了八大类中的91个交接班障碍和七大类中的140个交接班策略。18篇文章涉及交接班研究。研究的质量评估分数范围为1至13分（可能范围为1 - 16分）。三分之一的综述研究质量得分等于或低于8分，只有一篇得分为13分。只有六项研究包含任何交接班有效性的衡量指标。
尽管医生交接班不充分会产生负面后果，但为确定最佳实践所做的研究却很少。许多现有的同行评审研究存在设计或报告缺陷。轶事性建议的策略有显著的一致性；然而，仍然缺乏支持这些策略的确凿证据。总体而言，迫切需要开展高质量的交接班结果研究，关注系统因素、人员表现以及结构化方案和干预措施的有效性。
