Department of Internal Medicine, University of Virginia Healthsystem, P.O. Box 800744, Charlottesville, VA 22908, USA.
J Gen Intern Med. 2012 Mar;27(3):287-91. doi: 10.1007/s11606-011-1885-4. Epub 2011 Oct 14.
Resident duty hour restrictions have resulted in more frequent patient care handoffs, increasing the need for improved quality of residents' sign-out process.
To characterize resident sign-out process and identify effective strategies for quality improvement.
Mixed methods analysis of resident sign-out, including a survey of resident views, prospective observation and characterization of 64 consecutive sign-out sessions, and an appreciative-inquiry approach for quality improvement.
Internal medicine residents (n = 89).
An appreciative inquiry process identified five exemplar residents and their peers' effective sign-out strategies.
Surveys were analyzed and observations of sign-out sessions were characterized for duration and content. Common effective strategies were identified from the five exemplar residents using an appreciative inquiry approach.
The survey identified wide variations in the methodology of sign-out. Few residents reported that laboratory tests (13%) or medications (16%) were frequently accurate. The duration of observed sign-outs averaged 134 ±73 s per patient for the day shift (6 p.m.) sign-out compared with 59 ± 41 s for the subsequent night shift (8 p.m.) sign-out for the same patients (p = 0.0002). Active problems (89% vs 98%, p = 0.013), treatment plans (52% vs 73%, p = 0.004), and laboratory test results (56% vs 80%, p = 0.002) were discussed less commonly during night compared with day sign-out. The five residents voted best at sign-out (mean vote 11 ± 1.6 vs 1.7 ± 2.3) identified strategies for sign-out: (1) discussing acutely ill patients first, (2) minimizing discussion on straightforward patients, (3) limiting plans to active issues, (4) using a systematic approach, and (5) limiting error-prone chart duplication.
Resident views toward sign-out are diverse, and accuracy of written records may be limited. Consecutive sign-outs are associated with degradation of information. An appreciative-inquiry approach capitalizing on exemplar residents was effective at creating standards for sign-out.
住院医师工作时间限制导致患者交接更加频繁，因此需要提高住院医师交班质量。
描述住院医师交班流程，并确定提高交班质量的有效策略。
对住院医师交班进行混合方法分析，包括对住院医师意见的调查、对 64 次连续交班过程的前瞻性观察和描述，以及应用欣赏式探询法进行质量改进。
内科住院医师（n=89）。
应用欣赏式探询法确定了 5 名表现优秀的住院医师和他们的同事有效的交班策略。
对调查问卷进行分析，并对交班过程的持续时间和内容进行观察。应用欣赏式探询法从 5 名表现优秀的住院医师中确定常见的有效策略。
调查问卷结果显示，交班方法存在很大差异。很少有住院医师报告实验室检查（13%）或药物（16%）的结果经常准确。白天交接班时每位患者的平均交班时间为 134±73 s，而同一批患者晚上（8 点）交接班的时间为 59±41 s（p=0.0002）。夜间交班时，活跃问题（89%比 98%，p=0.013）、治疗计划（52%比 73%，p=0.004）和实验室检查结果（56%比 80%，p=0.002）的讨论频率较低。在交班表现得最好的 5 名住院医师（平均得分为 11±1.6 比 1.7±2.3）确定了交班策略：（1）首先讨论病情较重的患者，（2）尽量减少对病情简单患者的讨论，（3）将计划限于活跃问题，（4）使用系统方法，（5）减少容易出错的图表重复。
住院医师对交班的看法存在差异，书面记录的准确性可能有限。连续交班导致信息质量下降。利用表现优秀的住院医师的欣赏式探询法对于制定交班标准是有效的。
