Borowitz Stephen M., Waggoner-Fountain Linda A., Bass Ellen J., DeVoge Justin M.
Department of Pediatrics, University of Virginia, Charlottesville, VA (Dr. Borowitz and Dr. Waggoner-Fountain); Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA (Dr. Bass and Mr. Devoge)
Sign-out is a mechanism of transferring information, responsibility, and authority from one set of caregivers to another. In teaching hospitals, sign-out between resident physicians has a long tradition. Because of the need to reduce the number of hours residents spend in the hospital, the number of sign-outs has increased, while continuity of care during hospital stays has decreased. As a result, when caring for hospitalized patients, residents have become increasingly dependent upon exchange of information during sign-out. Despite its critical importance, little research has examined the content, process, and effectiveness of resident sign-out. Even less is known about how sign-out should be conducted or how interventions might improve the quality of sign-out. Between October 2005 and February 2006, and again between October 2006 and February 2007, residents completed a post-call survey immediately after a call shift; we also audio-recorded sign-out sessions. At baseline, an unexpected event arose during one-third of call shifts that should have been anticipated and discussed during sign-out. Recordings demonstrated sign-out was informal and unstructured with very wide variation in the type and extent of information exchanged. Based on these results, we explicitly defined the goals of sign-out; characterized information needed for concise, complete, and consistent sign-out; outlined a structured process to enhance the quality and efficiency of information exchange; developed a computerized tool to facilitate the process; and developed a curriculum to train residents how to sign-out more effectively. After implementing the new process and computer tool, the percentage of call nights when an unexpected event arose that should have been anticipated and discussed during sign-out was nearly identical to that at baseline. Although resident physicians frequently sign-out to one another, there are many times when important information is not transmitted. Future studies should be directed at identifying the information physicians need while on-call and clearly describing the goals and characteristics of a concise and complete sign-out. Additional studies are also needed to identify how to best teach and evaluate a physician’s ability to sign-out and how technology can be employed most effectively and appropriately.
交接班是将信息、责任和权力从一组医护人员传递给另一组医护人员的一种机制。在教学医院，住院医师之间的交接班有着悠久的传统。由于需要减少住院医师在医院的工作时长，交接班的次数增加了，而住院期间护理的连续性却下降了。因此，在护理住院患者时，住院医师越来越依赖于交接班时的信息交流。尽管其至关重要，但很少有研究考察住院医师交接班的内容、流程和效果。对于交接班应如何进行，或者干预措施如何提高交接班质量，了解得更少。在2005年10月至2006年2月期间，以及在2006年10月至2007年2月期间，住院医师在轮班后立即完成了一次交班后调查；我们还对交接班环节进行了录音。在基线时，三分之一的轮班期间出现了本应在交接班时预见并讨论的意外事件。录音显示，交接班是非正式且无组织的，所交换信息的类型和范围差异很大。基于这些结果，我们明确界定了交接班的目标；明确了简洁、完整和一致的交接班所需的信息；概述了一个结构化流程以提高信息交流的质量和效率；开发了一种计算机化工具来促进这一过程；并制定了一门课程来培训住院医师如何更有效地进行交接班。实施新流程和计算机工具后，在交接班时本应预见并讨论的意外事件出现的轮班夜间百分比与基线时几乎相同。尽管住院医师经常相互进行交接班，但很多时候重要信息并未传递。未来的研究应致力于确定医师值班时所需的信息，并清晰描述简洁完整的交接班的目标和特点。还需要进行更多研究，以确定如何最好地教授和评估医师的交接班能力，以及如何最有效和适当地利用技术。
