McCrory Michael Conor, Aboumatar Hanan, Custer Jason W, Yang Chris P, Hunt Elizabeth A
Departments of Anesthesiology and Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Pediatr Emerg Care. 2012 Jun;28(6):538-43. doi: 10.1097/PEC.0b013e3182587f6e.
This study was done to assess whether a modified "ABC-SBAR" mnemonic (airway, breathing, circulation followed by situation, background, assessment, and recommendation) improves hand-offs by pediatric interns in a simulated critical patient scenario.
Each of 26 interns reviewed a scenario involving a decompensating pediatric patient and gave a simulated hand-off to a responder. They received a didactic session on ABC-SBAR, then performed a second hand-off using another scenario. Two blinded reviewers assessed 52 video-recorded hand-offs for inclusion, order, and elapsed time to essential hand-off information using a scoring tool.
Mean score of hand-offs increased after ABC-SBAR training (preintervention: 3.1/10 vs postintervention: 7.8/10, P < 0.001). In hand-offs after ABC-SBAR training, the reason for the emergency call was more often prioritized before background information (preintervention: 4% vs postintervention: 81%, P < 0.001) and stated earlier (elapsed time preintervention: 19 seconds vs postintervention: 7 seconds, P < 0.001). Hand-offs including an airway or breathing assessment increased after training (preintervention: 35% vs postintervention: 85%, P = 0.001), and this information was also stated earlier (preintervention: 25 seconds vs postintervention: 5 seconds, P < 0.001). Total hand-off duration was increased (preintervention: 29 seconds vs postintervention: 36 seconds, P = 0.004).
Unstructured hand-off by interns in a simulated patient emergency emphasizes background information, leaving essential information (such as reason for the call and ABCs) delayed or omitted. ABC-SBAR was associated with improved inclusion and timeliness of essential information in simulated critical patient hand-offs by pediatric interns; however, hand-off duration was increased. Further studies are needed to elucidate optimal hand-off in an emergency situation.
本研究旨在评估改良后的“ABC-SBAR”助记法（气道、呼吸、循环，接着是情况、背景、评估和建议）是否能改善儿科实习生在模拟危重症患者场景中的交接班情况。
26名实习生每人审阅一个涉及失代偿儿科患者的场景，并向应答者进行模拟交接班。他们接受了关于ABC-SBAR的教学课程，然后使用另一个场景进行第二次交接班。两名盲法评审员使用评分工具对52次视频记录的交接班进行评估，以确定纳入情况、顺序以及获取关键交接班信息的用时。
ABC-SBAR培训后交接班的平均得分有所提高（干预前：3.1/10，干预后：7.8/10，P<0.001）。在ABC-SBAR培训后的交接班中，紧急呼叫的原因更常被优先于背景信息提及（干预前：4%，干预后：81%，P<0.001），且提及时间更早（干预前用时：19秒，干预后：7秒，P<0.001）。培训后包含气道或呼吸评估的交接班有所增加（干预前：35%，干预后：85%，P = 0.001），并且此信息提及时间也更早（干预前：25秒，干预后：5秒，P<0.001）。总的交接班时长增加了（干预前：29秒，干预后：36秒，P = 0.004）。
实习生在模拟患者紧急情况时进行的无组织交接班强调背景信息，导致关键信息（如呼叫原因和ABCs）延迟或遗漏。ABC-SBAR与改善儿科实习生在模拟危重症患者交接班中关键信息的纳入情况和及时性相关；然而，交接班时长增加了。需要进一步研究以阐明紧急情况下的最佳交接班方式。
