Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
Acad Med. 2010 Jul;85(7):1182-8. doi: 10.1097/ACM.0b013e3181da8370.
The safe transfer (handoff) of responsibility for patient care from one physician to another requires that health care facilities have rigorous sign-out systems and that physicians develop effective communication skills. In 2007 and 2008, to improve the spoken and written sign-out practices of the 25 interns at Allegheny General Hospital (Pittsburgh, Pennsylvania), the authors designed and administered Likert scale surveys about training in and satisfaction with current sign-out practices; directly observed and evaluated interns performing spoken sign-outs; assessed and graded interns' sign-out sheets; and compared sign-out sheets with patient records to evaluate their accuracy. On the basis of their findings, the authors developed a new curriculum with didactic and interactive components to target intern-level and system-level problems. The curriculum emphasized the importance of complete and accurate sign-outs, provided examples of good and poor sign-outs, and assigned interns to work in small groups to practice sign-out skills and receive feedback from peers and program leaders. Reevaluation of interns two months after curriculum implementation revealed not only better performance on each of the seven items evaluated for spoken sign-out but also substantial improvement in the completeness of sign-out sheets and the accuracy of reporting of identification data, code status, and medications data. The curriculum was well received by interns, and it helped them develop skills required by the Accreditation Council for Graduate Medical Education, including competencies in communication, practice-based learning, and systems-based practice.
安全地将患者护理责任从一位医生转移到另一位医生，需要医疗机构有严格的交班系统，并且医生要具备有效的沟通技巧。在 2007 年和 2008 年，为了改善宾夕法尼亚州匹兹堡阿勒格尼总医院 25 名实习医生的口头和书面交班实践，作者设计并管理了关于当前交班实践的培训和满意度的李克特量表调查；直接观察和评估实习医生进行口头交班的情况；评估和评分实习医生的交班单；并将交班单与患者记录进行比较，以评估其准确性。根据他们的发现，作者开发了一个新的课程，包括理论和互动部分，以解决实习医生层面和系统层面的问题。该课程强调了完整和准确交班的重要性，提供了良好和不良交班的示例，并分配实习医生分组练习交班技能，并从同事和项目负责人那里获得反馈。在课程实施两个月后对实习医生进行重新评估，不仅发现口头交班的七项评估项目中的每一项表现都有所提高，而且交班单的完整性和识别数据、编码状态和药物数据报告的准确性也有了显著提高。该课程受到实习医生的欢迎，并帮助他们培养了研究生医学教育认证委员会要求的技能，包括沟通、基于实践的学习和基于系统的实践能力。
