Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Am Coll Surg. 2010 Jan;210(1):17-22. doi: 10.1016/j.jamcollsurg.2009.09.025. Epub 2009 Oct 28.
The Joint Commission on the Accreditation of Healthcare Organizations reports that communication breakdowns are responsible for 85% of sentinel events in hospitals. Patients in surgical ICUs are the most vulnerable to communication errors. Fellows and residents are an integral part of the surgical ICU team, but little is known about resident-fellow communication and its impact on surgical ICU patient outcomes. The objective of this study is to describe resident-fellow patient care communication patterns in the surgical ICU and correlate established communication patterns with short-term outcomes.
A prospective observational trial was conducted for 136 consecutive surgical ICU days. We evaluated resident-fellow communication of four cardiorespiratory events: hypotension, new arrhythmias, tachypnea, and desaturation. We prospectively defined three short-term outcomes: improved, not improved, and worse. An intervention was attempted to improve communication.
Three hundred twelve events were collected (166 observational and 146 interventional). PGY3 residents covered approximately 60% of days in both phases. PGY3 residents were responsible for 73% of communication errors in the observational phase and 59% of communication errors in the interventional phase. Communication errors were more likely in the late shift (p < 0.0001). The late shift was responsible for 77% of all communication errors. Communication errors resulted in worse short-term outcomes for cardiorespiratory events (p < 0.0002). Effective communication was a significant predictor of improved short-term outcomes (p < 0.0003). The intervention decreased communication errors in the late shift by 10% (p < 0.052).
Communication errors occurred more frequently during the late shift. These communication errors were associated with worsened short-term outcomes. Improved communication in the surgical ICU is a fruitful target to improve clinical outcomes.
医疗保健组织联合委员会报告称，沟通中断导致医院 85%的警戒事件。外科重症监护病房的患者最容易受到沟通错误的影响。住院医师和研究员是外科重症监护病房团队的重要组成部分，但对住院医师-研究员之间的沟通及其对外科重症监护病房患者结果的影响知之甚少。本研究的目的是描述外科重症监护病房住院医师-研究员的患者护理沟通模式，并将既定的沟通模式与短期结果相关联。
对 136 个连续的外科重症监护病房日进行了前瞻性观察性试验。我们评估了四名心肺事件的住院医师-研究员之间的沟通：低血压、新心律失常、呼吸急促和缺氧。我们前瞻性地定义了三个短期结果：改善、未改善和恶化。尝试进行干预以改善沟通。
共收集了 312 个事件（166 个观察性事件和 146 个干预性事件）。PGY3 住院医师在两个阶段都负责大约 60%的天数。PGY3 住院医师在观察阶段负责 73%的沟通错误，在干预阶段负责 59%的沟通错误。沟通错误更可能发生在夜班（p < 0.0001）。夜班负责了所有沟通错误的 77%。沟通错误导致心肺事件的短期结果更差（p < 0.0002）。有效的沟通是改善短期结果的重要预测因素（p < 0.0003）。干预措施使夜班的沟通错误减少了 10%（p < 0.052）。
夜班时沟通错误更频繁。这些沟通错误与短期结果恶化有关。改善外科重症监护病房的沟通是提高临床结果的一个有成效的目标。
