School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada.
J Patient Saf. 2011 Mar;7(1):11-8. doi: 10.1097/PTS.0b013e31820c98a8.
Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting.
A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies.
A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential.
Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.
许多当代急性护理机构缺乏安全有效的临床交接实践，导致患者在交接过程中容易出现护理连续性中断、医疗错误和不良的患者安全事件。本文旨在通过为寻求改善急性护理环境中临床交接安全性和有效性的领导和管理人员提供实用指南，补充现有的交接改进文献。
应用四阶段变革模型来指导交接改进策略的应用。变革管理和质量改进原则，以及从安全科学和高可靠性组织中汲取的概念，被应用于策略的制定。
提出了一个尊重交接复杂性的交接改进模型。针对变革阶段的策略包括以下内容：1. 在战略方向、问责制、终端用户参与和问题复杂性识别的支持下，增强对手头交接问题和机会的认识。2. 通过在当地背景下应用和调整最佳实践来确定解决方案。3. 通过沟通、文件记录和培训来实施在当地进行调整的最佳实践。4. 通过整合、监测和积极传播来使实践的改变制度化。最后，每个阶段都需要持续评估。
尽管交接过程和功能知识方面仍存在差距，但改善交接安全性和有效性的努力仍然是可能的。持续评估对于建立这种理解和确保实践的改变能够提高患者安全性、组织效能以及患者和提供者的满意度至关重要。通过交接知识的建立，交接政策和实践可能会发生根本性的改变。
