Boggan Joel C, Zhang Tian, Derienzo Chris, Frush Karen, Andolsek Kathryn
J Grad Med Educ. 2013 Dec;5(4):652-7. doi: 10.4300/JGME-D-12-00287.
Compliance with the Accreditation Council for Graduate Medical Education duty hour standards may necessitate more frequent transitions of patient responsibility.
We created a multidisciplinary Patient Safety and Quality Council with a Task Force on Handoffs (TFH), engaging residents at a large, university-based institution.
The TFH identified core content of effective handoffs and patterned institutional content on the SIGNOUTT mnemonic. A web-based module highlighting core content was developed for institutional orientation of all trainees beginning summer 2011 to standardize handoff education. The TFH distributed handoff material and catalogued additional program initiatives in teaching and evaluating handoffs. A standard handoff evaluation tool, assessing content, culture, and communication, was developed and "preloaded" into the institution-wide electronic evaluation system to standardize evaluation. The TFH developed questions pertaining to handoffs for an annual institutional survey in 2011 and 2012. Acceptability of efforts was measured by program participation, and feasibility was measured by estimating time and financial costs.
Programs found the TFH's efforts to improve handoffs acceptable; to date, 13 program-specific teaching initiatives have been implemented, and the evaluation tool is being used by 5 programs. Time requirements for TFH participants average 2 to 3 h/mo, and financial costs are minimal. More residents reported having education on handoffs (58% [388 of 668] versus 42% [263 of 625], P < .001) and receiving adequate signouts (69% [469 of 680] versus 61% [384 of 625], P = .004) in the 2012 survey, compared with 2011.
Use of a multispecialty resident leadership group to address content, education, and evaluation of handoffs was feasible and acceptable to most programs at a large, university-based institution.
遵守毕业后医学教育认证委员会的工作时间标准可能需要更频繁地交接患者责任。
我们成立了一个多学科的患者安全与质量委员会，并设立了一个交接班特别工作组（TFH），让一所大型大学附属医院的住院医师参与其中。
TFH确定了有效交接班的核心内容，并以SIGNOUTT记忆法为基础制定了机构内容模板。2011年夏季开始，为所有实习生开发了一个突出核心内容的网络模块，用于机构培训，以规范交接班教育。TFH分发了交接班材料，并对教学和评估交接班的其他项目举措进行了编目。开发了一种标准的交接班评估工具，用于评估内容、文化和沟通情况，并“预加载”到全机构的电子评估系统中，以规范评估。TFH为2011年和2012年的年度机构调查制定了与交接班相关的问题。通过项目参与度来衡量措施的可接受性，通过估计时间和财务成本来衡量可行性。
各项目认为TFH为改善交接班所做的努力是可接受的；迄今为止，已实施了13项针对特定项目的教学举措，5个项目正在使用评估工具。TFH参与者的时间要求平均为每月2至3小时，财务成本很低。与2011年相比，在2012年的调查中，更多的住院医师报告接受了交接班教育（58%[668人中的388人]对42%[625人中的263人]，P<0.001），并且收到了充分的交班报告（69%[680人中的469人]对61%[625人中的384人]，P = 0.004）。
在一所大型大学附属医院，利用多专业住院医师领导团队来处理交接班的内容、教育和评估是可行的，并且大多数项目都能接受。
