Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Ann Surg. 2011 May;253(5):849-54. doi: 10.1097/SLA.0b013e3181f4dfc8.
To develop and evaluate an intervention to reduce breakdowns in communication during inpatient surgical care.
Communication breakdowns are the second most common cause of avoidable surgical adverse events after technical errors.
In a pre- and postintervention study, a random selection of patients on the surgical services of 4 teaching hospitals were observed according to 3 measures: (1) resident-attending communication of critical patient events (eg, transfer into the intensive care unit, unplanned intubation, cardiac arrest); (2) resident-attending notification regarding routine weekend patient status; and (3) frequency of weekend patient visits by an attending. All departments then developed and adopted a set of policy and education initiatives designed to increase prompt and consistent resident-attending communication (especially in critical events) and to improve regular attending visits with surgical patients. Specific reinforcement of the policies included a pocket information card for residents, as well as periodic reminders. Repeat audits of the surgical services were then conducted.
We reviewed information for 211 critical events and 1360 patients for the nature of resident and attending communication practices. After the intervention, the proportion of critical events not conveyed to an attending decreased from 33% (26/80) to 2% (1/47), and gaps in the frequency of attending notification of patient status on weekends were virtually eliminated (P < 0.0001); the proportion of weekend patients not visited by an attending for greater than 24 hours decreased by half (from 61% to 33%; P = 0.0002). Contact resulted in attending-led changes in patient management in one-third of cases.
An intervention to improve surgical communication practices at 4 teaching hospitals led to significant reductions in potentially harmful communication breakdowns during inpatient care; significant alterations in patient management were noted in one-third of cases in which there was an adherence to recommended communication practices.
开发并评估一项干预措施，以减少住院手术护理过程中的沟通障碍。
沟通障碍是仅次于技术错误的第二类可避免手术不良事件的原因。
在一项干预前后的研究中，根据 3 项措施观察了 4 所教学医院外科病房的随机选择患者：（1）住院医师与主治医生之间关于关键患者事件（如转入重症监护病房、非计划性插管、心脏骤停）的沟通；（2）住院医师在周末向主治医生报告常规患者状况；（3）主治医生在周末探访患者的频率。所有科室随后制定并采用了一系列政策和教育措施，旨在增加住院医师和主治医生之间及时、一致的沟通（尤其是在关键事件中），并改善主治医生对手术患者的定期探访。这些政策的具体强化措施包括为住院医师提供口袋信息卡，以及定期提醒。随后对外科服务进行了重复审核。
我们审查了 211 个关键事件和 1360 名患者的信息，以了解住院医师和主治医生沟通实践的性质。干预后，未传达给主治医生的关键事件比例从 33%（26/80）降至 2%（1/47），周末主治医生通知患者状况的频率差距几乎消除（P < 0.0001）；超过 24 小时未由主治医生探访的周末患者比例减少了一半（从 61%降至 33%；P = 0.0002）。三分之一的情况下，由于沟通，主治医生对患者管理进行了调整。
在 4 所教学医院中，一项旨在改善外科沟通实践的干预措施导致住院期间潜在有害沟通障碍显著减少；在三分之一的情况下，建议的沟通实践得到遵守，患者管理发生了重大改变。
