Boat Anne C, Spaeth James P
Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Paediatr Anaesth. 2013 Jul;23(7):647-54. doi: 10.1111/pan.12199. Epub 2013 May 18.
Ineffective communications among healthcare providers are common and increases the risk of medical errors. During the perioperative period, multiple handoffs occur within a short period of time, and failure to convey important patient information can compromise safety. We used quality improvement methodology to improve the reliability of our handoffs in the operating room and postanesthesia care unit (PACU).
Two quality improvement teams were developed to focus on the intraoperative and postanesthesia handoff processes. Key driver diagrams and 'smart aims' were developed for each process based on feedback from anesthesia and nursing staff, and handoff checklists were developed and revised using multiple plan-do-study-act cycles. Data on the reliability of the handoff processes were obtained prior to initiation of the projects and throughout the 6-month project period.
The reliability of intraoperative anesthesia handoffs improved from 20% to 100% with use of the intraoperative handoff checklist. Similarly, with the introduction of a standardized PACU checklist, the reliability of PACU handoffs improved from 59% to greater than 90%.
We utilized quality improvement methodology to develop and implement standardized checklists for handoffs of care in the operating room and PACU. Acceptance of and adherence to the standardized handoff protocols dramatically increased the quality and reliability of our handoff process.
医疗服务提供者之间的沟通不畅很常见，会增加医疗差错风险。在围手术期，短时间内会发生多次交接，未能传达重要的患者信息会危及安全。我们采用质量改进方法来提高手术室和麻醉后护理单元（PACU）交接的可靠性。
成立了两个质量改进团队，分别专注于术中及麻醉后交接流程。根据麻醉和护理人员的反馈，为每个流程制定了关键驱动因素图和“明确目标”，并通过多个计划-执行-研究-行动循环来制定和修订交接检查表。在项目启动前及整个6个月的项目期间，获取了交接流程可靠性的数据。
使用术中交接检查表后，术中麻醉交接的可靠性从20%提高到了100%。同样，随着标准化PACU检查表的引入，PACU交接的可靠性从59%提高到了90%以上。
我们利用质量改进方法，为手术室和PACU的护理交接制定并实施了标准化检查表。对标准化交接协议的接受和遵守显著提高了我们交接流程的质量和可靠性。
