Center for Patient Safety, University Medical Center Utrecht, Utrecht, The Netherlands.
Anesth Analg. 2012 Nov;115(5):1183-7. doi: 10.1213/ANE.0b013e31826996a2. Epub 2012 Sep 13.
Loss of information occurs frequently during handover and affects the continuity of care. Improving handovers is therefore a key patient safety goal. After surgery, the patient is transferred to the postanesthesia care unit (PACU), and handover to the nurse includes both handover of monitoring equipment (connecting electrocardiogram, calibrating arterial lines, infusion pumps, etc.) and patient/procedure-specific information. Multitasking is likely to increase the risk of information loss during handover. It is unknown to what extent the transfer of equipment and information occurs simultaneously or sequentially in daily practice.
A nationwide questionnaire on the subject of patient handover was returned by 494 health care practitioners concerned with handovers from operating room (OR) to PACU. In addition, 101 handovers from the OR to the PACU were videotaped in 2 academic hospitals (n = 20), 3 teaching hospitals (n = 43) and 1 community hospital (n = 38). The occurrence of simultaneous or sequential transfer of equipment and information was recorded by two independent observers.
Simultaneous handover of equipment and information was the preference for a minority of respondents to the national survey (11%, 95% confidence interval, 8% to 14%). Self-reported simultaneous handover was 43% (39% to 47%). In the videotaped handovers, simultaneous handover was used for 65% (56% to 74%), which was even higher in the academic centers. The simultaneous handovers were no more than 0.2 minute faster than sequential handovers (P = 0.38).
In most videotaped handovers from OR to the PACU, there was simultaneous transfer of equipment and information. Although most health care providers are unaware of it, this form of multitasking during patient handover in the PACU is common. Future studies should evaluate whether this multitasking also leads to loss of critical patient information and reduced patient safety.
交接过程中经常会出现信息丢失的情况，这会影响医疗服务的连续性。因此，改善交接流程是患者安全的关键目标之一。手术后，患者会被转送至麻醉后护理病房（PACU），护士需要交接监测设备（连接心电图、校准动脉管路、输注泵等）和患者/手术相关信息。在交接过程中同时处理多项任务可能会增加信息丢失的风险。目前尚不清楚在日常实践中，设备和信息的交接是同时进行还是顺序进行。
一项关于患者交接的全国性问卷调查共收到 494 名与手术室（OR）至 PACU 交接工作相关的医护人员的回复。此外，在 2 所学术医院（n = 20）、3 所教学医院（n = 43）和 1 所社区医院（n = 38）共记录了 101 次从 OR 到 PACU 的交接过程。两名独立观察员记录设备和信息同时或顺序交接的情况。
对于全国性调查的少数受访者（11%，95%置信区间，8%至 14%）来说，设备和信息的同时交接是首选。自我报告的同时交接率为 43%（39%至 47%）。在记录的交接过程中，同时交接的比例为 65%（56%至 74%），在学术中心甚至更高。同时交接的速度比顺序交接快不超过 0.2 分钟（P = 0.38）。
在大多数从 OR 到 PACU 的记录交接中，设备和信息同时交接。尽管大多数医护人员没有意识到这一点，但这种在 PACU 进行患者交接时的多重任务处理方式很常见。未来的研究应评估这种多重任务处理是否也会导致关键患者信息的丢失和患者安全性的降低。
