Division of General Internal Medicine, New York University-Langone Medical Center, New York, NY, USA.
J Gen Intern Med. 2013 Jan;28(1):114-20. doi: 10.1007/s11606-012-2206-2. Epub 2012 Sep 19.
In an effort to prevent medical errors, it has been recommended that all healthcare organizations implement a standardized approach to communicating patient information during transitions of care between providers. Most research on these transitions has been conducted in the inpatient setting, with relatively few studies conducted in the outpatient setting.
To develop a structured transfer of care program in an academic outpatient continuity practice and evaluate whether this program improved patient safety as measured by the documented completion of patient care tasks at 3 months post-transition.
Graduating residents and the corresponding incoming interns inheriting their continuity patient panels were randomized to the pilot structured transfer group or the standard transfer group. The structured transfer group residents were asked to complete written and verbal sign-outs with their interns; the standard transfer group residents continued the current standard of care.
Thirty-two resident-intern pairs in an academic internal medicine residency program in New York City.
Three months after the transition, study investigators evaluated whether patient care tasks assigned by the graduating residents had been successfully completed by the interns in both groups. In addition, follow-up appointments, continuity of care and house officer satisfaction with the sign-out process were evaluated.
Among patients seen during the first 3 months, the clinical care tasks were more likely to be completed by interns in the structured group (73 %, n = 49) versus the standard group (46 %, n = 28) (adjusted OR 3.21; 95 % CI 1.55-6.62; p = 0.002). This was further enhanced if the intern who saw the patient was also the assigned primary care provider (adjusted OR 4.26; 95 % CI 1.7-10.63; p = 0.002).
A structured outpatient sign-out improved the odds of follow-up of important clinical care tasks after the year-end resident clinic transition. Further efforts should be made to improve residents' competency with regard to sign-outs in the ambulatory setting.
为了防止医疗失误，已经建议所有医疗保健组织在提供者之间的护理过渡期间采用标准化的方法来传递患者信息。大多数关于这些过渡的研究都是在住院环境中进行的，而在门诊环境中进行的研究相对较少。
在学术门诊连续性实践中开发一种结构化的交接护理计划，并评估该计划是否通过在交接后 3 个月记录完成患者护理任务来提高患者安全性。
即将毕业的住院医师和继承其连续性患者小组的相应入职实习生被随机分配到试点结构化交接组或标准交接组。结构化交接组的住院医师被要求与他们的实习生完成书面和口头交接；标准交接组的住院医师继续采用当前的标准护理。
纽约市一所学术内科住院医师培训计划中的 32 对住院医师-实习生。
在交接后 3 个月，研究调查人员评估两组实习生是否成功完成了即将毕业的住院医师分配的患者护理任务。此外，还评估了随访预约、连续性护理和住院医师对交接过程的满意度。
在交接后 3 个月内，在接受治疗的患者中，结构化组的实习生更有可能完成临床护理任务（73%，n=49），而标准组的实习生则更有可能完成（46%，n=28）（调整后的 OR 3.21；95%CI 1.55-6.62；p=0.002）。如果接受患者治疗的实习生也是指定的初级保健提供者，则效果会进一步增强（调整后的 OR 4.26；95%CI 1.7-10.63；p=0.002）。
结构化的门诊交接提高了在年底住院医师诊所过渡后随访重要临床护理任务的可能性。应进一步努力提高住院医师在门诊环境中进行交接的能力。
