Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Hosp Med. 2010 Nov-Dec;5(9):547-52. doi: 10.1002/jhm.808. Epub 2010 Aug 17.
Handoffs, or transfers of patient care responsibility, occur frequently on hospitalist teams. The reliability and efficiency of the handoff process is a national and local concern. Most studies in the literature regard physicians-in-training. We studied the morning handoff process of hospitalist teams comprised of staff physicians and nurse practitioner and/or physician assistants.
An improvement team observed morning handoffs. Four problems were identified: unpredictable start and finish times, inefficiency, poor environment (hallway noise and distracting in-room conversations), and poor communication. The team restructured the process and observed post-intervention behavior at 15 and 90 days. A participant-provider survey was conducted before and after the intervention regarding wasted time, total time-in-report, and satisfaction with the process.
Pre-intervention 60.5% of providers (23/38) believed morning handoff was performed in a timely fashion compared to 100% (15/15) post-intervention (P = 0.005). Average time spent in morning report was 11 minutes, compared to 5 minutes after the intervention (P < 0.0028). Pre-intervention 6.5 minutes were believed wasteful, compared to 0.5 minutes post-intervention (P < 0.0001).
This study identifies deficiencies in the handoff process that were addressed by enhancing the physical environment (smaller room, noise reduction, closed door), assigned seating (visual cues by table tent cards), non-clinicians providing printed materials, standardization of written updates, team times (consistent & precise daily time for each team report), culture change including deference of attention to team receiving report with opportunity for questions, and minimization of side conversations. This intervention package resulted in an improvement in satisfaction and timeliness of clinicians involved.
在医院医师团队中，经常会进行交接，即患者护理责任的转移。交接过程的可靠性和效率是一个全国性和地方性的问题。文献中的大多数研究都涉及到接受培训的医生。我们研究了由主治医生、护士从业者和/或医师助理组成的医院医师团队的晨间交接过程。
一个改进团队观察了晨间交接。确定了四个问题：不可预测的开始和结束时间、效率低下、较差的环境（走廊噪音和房间内分散注意力的对话）以及沟通不畅。团队对流程进行了重组，并在干预后 15 天和 90 天观察干预后的行为。在干预前后，对参与者和提供者进行了关于浪费时间、总报告时间和对流程满意度的调查。
干预前，60.5%（23/38）的提供者认为晨间交接及时进行，而干预后，100%（15/15）的提供者认为是及时的（P = 0.005）。晨间报告的平均时间为 11 分钟，而干预后为 5 分钟（P < 0.0028）。干预前，6.5 分钟被认为是浪费时间，而干预后，0.5 分钟被认为是浪费时间（P < 0.0001）。
这项研究确定了交接过程中的缺陷，并通过增强物理环境（较小的房间、减少噪音、关门）、指定座位（通过桌卡提供视觉提示）、非临床人员提供印刷材料、标准化书面更新、团队时间（为每个团队报告分配一致且精确的每日时间）、文化变革（包括尊重接收报告的团队并提供提问机会）以及最小化旁支对话来解决这些缺陷。这种干预措施改善了参与的临床医生的满意度和及时性。
