Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA.
J Hosp Med. 2009 Nov;4(9):535-40. doi: 10.1002/jhm.523.
Little data exist to inform hospitalist communication during service changes.
To characterize hospitalist handoffs during service changes.
Serial survey study.
Single academic medical center.
From May to December 2007, 60 service changes among 17 hospitalists on a nonteaching service were targeted for evaluation using an anonymous 18-item survey that was completed by hospitalists within 48 hours of assuming care for patients. Survey items assessed completeness of handoff communication, certainty of patient care plans, missed information, time spent recovering information, and near misses/adverse events due to incomplete handoffs. The association between completeness of communication and handoff outcomes was examined. Narrative comments were analyzed qualitatively.
Ninety-three percent (56/60) of surveys were returned. All 17 hospitalists participated. Thirteen percent of respondents reported incomplete handoffs and 18% were uncertain of care plan on transition day. At least 1 near miss, attributable to incomplete communication was reported by 16%. Hospitalists who reported incomplete handoffs were more likely to report uncertainty about patient care plans on the transition day (71% incomplete vs. 10% complete, P < 0.01), discovery of missing information (71% incomplete vs. 24% complete, P = 0.01), near misses/adverse events (57% incomplete vs. 10% complete, P < 0.01), and more time resolving issues arising from missed information (71% incomplete vs. 22% complete, P < 0.01). Qualitative comments suggest the need for a more systematic, focused, team-based, and patient-centered handoff model.
Incomplete handoffs during service changes are associated with uncertainty and potential patient harm. Suggestions to improve the completeness of hospitalist service change communications are offered.
关于服务变更期间医院医生沟通的信息很少。
描述服务变更期间医院医生的交接情况。
连续调查研究。
单家学术医疗中心。
2007 年 5 月至 12 月，17 名医院医生中的 60 名在非教学服务中进行了服务变更，他们通过在承担患者护理后 48 小时内完成的匿名 18 项调查，对服务变更进行评估。调查项目评估了交接沟通的完整性、患者护理计划的确定性、遗漏信息、恢复信息所花费的时间，以及因交接不完整而导致的险些发生/不良事件。检查了沟通的完整性与交接结果之间的关联。对叙述性评论进行了定性分析。
93%（56/60）的调查得到了回复。所有 17 名医院医生都参与了调查。13%的受访者报告了交接不完整，18%的受访者在交接日对护理计划不确定。16%的受访者报告至少发生了 1 起险些发生的不良事件，归因于沟通不完整。报告交接不完整的医院医生更有可能在交接日对患者护理计划不确定（71%不完整与 10%完整，P < 0.01），发现信息缺失（71%不完整与 24%完整，P = 0.01），险些发生/不良事件（57%不完整与 10%完整，P < 0.01），以及花更多的时间解决因信息缺失而产生的问题（71%不完整与 22%完整，P < 0.01）。定性评论表明需要一个更系统、更集中、以团队为基础和以患者为中心的交接模式。
服务变更期间的交接不完整与不确定性和潜在的患者伤害有关。提出了改进医院医生服务变更沟通完整性的建议。
