Catchpole Ken, Sellers Richard, Goldman Allan, McCulloch Peter, Hignett Sue
Nuffield Department of Surgery, University of Oxford, The John Radcliffe, Headington, Oxford OX3 9DU, UK.
Qual Saf Health Care. 2010 Aug;19(4):318-22. doi: 10.1136/qshc.2009.026542. Epub 2010 Jun 17.
This paper expands the analogy between motor racing team pit stops and patient handovers. Previous studies demonstrated how the handover of patients following surgery could be improved by learning from a motor racing team. This has been extended to include contributions from several motor racing teams, and by examining transfers at several different interfaces at a non-specialist UK teaching hospital.
Letters of invitation were sent to the technical managers of nine Formula 1 motor racing teams. Semistructured interviews were carried out at a UK teaching hospital with 10 clinical staff involved in the handover of patients from surgery to recovery and intensive care.
Three themes emerged from the motor racing responses; (1) proactive learning with briefings and checklists to prevent errors; (2) active management using technology to transfer information, and (3) post hoc learning from the storage and analysis of electronic data records. The eight healthcare themes were: historical working practice; problems during transfer; poor awareness of handover protocols; poor team coordination; time pressure; lack of consistency in handover practice; poor communication of important information; and awareness that handover was a potential threat to patient safety.
The lessons from motor racing can be applied to healthcare for proactive planning, active management and post hoc learning. Other high-risk industries see standardisation of working practices, interpersonal communication, consistency and continuous development as fundamental for success. The application of these concepts would result in improvements in the quality and safety of the patient handover process.
本文拓展了赛车维修站进站加油与患者交接之间的类比。先前的研究表明，借鉴赛车团队的经验可以改进术后患者的交接工作。这一研究已扩展至多个赛车团队的贡献，并在英国一家非专科教学医院的多个不同交接环节进行了考察。
向九支一级方程式赛车车队的技术经理发出邀请信。在一家英国教学医院，对10名参与患者从手术到康复及重症监护交接工作的临床工作人员进行了半结构化访谈。
赛车团队的回复中出现了三个主题：（1）通过简报和检查表进行主动学习以防止错误；（2）利用技术传递信息进行主动管理；（3）从电子数据记录的存储和分析中进行事后学习。医疗保健方面的八个主题是：历史工作惯例；交接过程中的问题；对交接规程认识不足；团队协作不佳；时间压力；交接实践缺乏一致性；重要信息沟通不畅；以及意识到交接对患者安全是潜在威胁。
赛车运动的经验教训可应用于医疗保健领域，用于主动规划、主动管理和事后学习。其他高风险行业将工作实践的标准化、人际沟通、一致性和持续发展视为成功的基础。应用这些理念将改善患者交接过程的质量和安全性。
