Downey La Vonne, Zun Leslie, Burke Trena
Health Services/Public Administration Department, Roosevelt University, Chicago, Illinois, USA.
Department of Emergency Medicine, Chicago, Mount Sinai Hospital, Illinois, USA.
Int J Health Care Qual Assur. 2013;26(8):760-7. doi: 10.1108/IJHCQA-03-2012-0028.
The aim is to determine, from the patient's perspective, what constitutes a good hand-off procedure in the emergency department (ED). The secondary purpose is to evaluate what impact a formalized hand-off had on patient knowledge, throughput and customer service
DESIGN/METHODOLOGY/APPROACH: This study used a randomized controlled clinical trial involving two unique hand-off approaches and a convenience sample. The study alternated between the current hand-off process that documented the process but not specific elements (referred to as the informal process) to one using the IPASS the BATON process (considered the formal process). Consenting patients completed a 12-question validated questionnaire on how the process was perceived by patients and about their understanding why they waited in the ED. Statistical analysis using SPSS calculated descriptive frequencies and t-tests.
In total 107 patients were enrolled: 50 in the informal and 57 in the formal group. Most patients had positive answers to the customer survey. There were significant differences between formal and informal groups: recalling the oncoming and outgoing physician coming to the patient's bed (p = 0.000), with more formal group recalling that than informal group patients; the oncoming physician introducing him/herself (p = 0.01), with more from the formal group answering yes and the physician discussing tests and implications with formal group patients (p = 0.02).
RESEARCH LIMITATIONS/IMPLICATIONS: This study was done at an urban inner city ED, a fact that may have skewed its results. A comparison of suburban and rural EDs would make the results stronger. It also reflected a very high level of customer satisfaction within the ED. This lack of variance may have meant that the correlation between customer service and handoffs was missed or underrepresented. There was no codified observation of either those using the IPASS the BATON script or those using informal procedures, so no comparison of level and types of information given between the two groups was done. There could have been a bias of those attending who had internalized the IPASS the BATON procedures and used them even when they were assigned to the informal group.
A hand off from one physician to the next in the emergency department is best done using a formalized process. IPASS the BATON is a useful tool for hand off in the ED in part because it involved the patient in the process. The formal hand off increased communication between patient and doctor as its use increased the patient's opportunity to ask and respond to questions.
ORIGINALITY/VALUE: The researchers evaluated an ED physician specific hand-off process and illustrate the value and impact of involving patients in the hand-off process.
从患者的角度确定在急诊科什么构成良好的交接班流程。次要目的是评估正式交接班对患者知识、诊疗效率及客户服务有何影响。
设计/方法/途径：本研究采用随机对照临床试验，涉及两种独特的交接班方法及便利样本。研究在记录流程但未记录具体要素的当前交接班流程（称为非正式流程）与使用IPASS交接流程（视为正式流程）之间交替进行。同意参与的患者完成一份包含12个问题的有效问卷，内容涉及患者对流程的看法以及他们对在急诊科等待原因的理解。使用SPSS进行统计分析，计算描述性频率和t检验。
共招募107名患者：非正式组50名，正式组57名。大多数患者对客户调查给出肯定回答。正式组和非正式组之间存在显著差异：回忆起即将接手和即将交班的医生来到患者床边的情况（p = 0.000），正式组回忆起的患者多于非正式组；即将接手的医生进行自我介绍的情况（p = 0.01），正式组回答“是”的更多；以及医生与正式组患者讨论检查及影响的情况（p = 0.02）。
研究局限性/启示：本研究在城市中心的急诊科进行，这一事实可能使结果产生偏差。对郊区和农村急诊科进行比较会使结果更具说服力。研究还反映出急诊科内客户满意度非常高。这种缺乏差异的情况可能意味着错过或未充分体现客户服务与交接班之间的相关性。对于使用IPASS交接脚本的人员和使用非正式程序的人员，均未进行系统观察，因此未对两组提供的信息水平和类型进行比较。那些已经熟悉IPASS交接程序的参与者可能存在偏差，即使他们被分配到非正式组，仍会使用该程序。
在急诊科，一名医生向下一名医生进行交接时，最好采用正式流程。IPASS交接流程是急诊科交接的有用工具，部分原因是它让患者参与到流程中。正式交接增加了医患之间的沟通，因为其使用增加了患者提问和回答问题的机会。
原创性/价值：研究人员评估了针对急诊科医生的特定交接流程，并阐述了让患者参与交接流程的价值和影响。
