Luther Vishal, Hammersley Daniel, Chekairi Ahmed
Cardiology ST4 in the Department of Cardiology and General Medicine, Ealing Hospital, Middlesex.
Core Medical Trainee Year 1 in the Department of Gastroenterology and General Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex.
Br J Hosp Med (Lond). 2014 Jan;75(1):44-7. doi: 10.12968/hmed.2014.75.1.44.
Medical admission units are continuously under pressure to move patients off the unit to outlying medical wards and allow for new admissions. In a typical district general hospital, doctors working in these medical wards reported that, on average, three patients each week arrived from the medical admission unit before any handover was received, and a further two patients arrived without any handover at all. A quality improvement project was therefore conducted using a 'Plan, Do, Study, Act' cycle model for improvement to address this issue.
P - Plan: as there was no framework to support doctors with handover, a series of standard handover procedures were designed. D - Do: the procedures were disseminated to all staff, and championed by key stakeholders, including the clinical director and matron of the medical admission unit.
S - STUDY: Measurements were repeated 3 months later and showed no change in the primary end points. A - ACT: The post take ward round sheet was redesigned, creating a checkbox for a medical admission unit doctor to document that handover had occurred. Nursing staff were prohibited from moving the patient off the ward until this had been completed. This later evolved into a separate handover sheet. Six months later, a repeat study revealed that only one patient each week was arriving before or without a verbal handover.
Using a 'Plan, Do, Study, Act' business improvement tool helped to improve patient care.
医疗收治单元持续面临将患者转出至偏远医疗病房以接纳新患者的压力。在一家典型的地区综合医院，这些医疗病房的医生报告称，平均每周有三名患者在未进行任何交接的情况下从医疗收治单元转来，另有两名患者根本没有任何交接就转来了。因此，开展了一项质量改进项目，采用“计划、执行、研究、行动”循环模型来解决这一问题。
P - 计划：由于没有支持医生进行交接的框架，设计了一系列标准交接程序。D - 执行：将这些程序分发给所有工作人员，并由关键利益相关者倡导，包括医疗收治单元的临床主任和护士长。
S - 研究：3个月后重复进行测量，结果显示主要终点没有变化。A - 行动：重新设计了接收后病房查房表，设置了一个复选框，供医疗收治单元的医生记录交接已完成。在交接完成之前，禁止护理人员将患者转出病房。这后来演变成了一份单独的交接表。6个月后，重复研究显示，每周只有一名患者在进行口头交接之前或没有进行口头交接的情况下转来。
使用“计划、执行、研究、行动”业务改进工具有助于改善患者护理。
