住院医师在岗可减少外科重症监护病房的沟通错误。

In-hospital fellow coverage reduces communication errors in the surgical intensive care unit.

作者信息

Williams Mallory, Alban Rodrigo F, Hardy James P, Oxman David A, Garcia Edward R, Hevelone Nathanael, Frendl Gyorgy, Rogers Selwyn O

机构信息

Department of Surgery, University of Toledo Medical Center, Toledo, OH.

Department of Surgery, Orlando Regional Medical Center, Orlando, FL.

出版信息

J Crit Care. 2014 Jun;29(3):445-9. doi: 10.1016/j.jcrc.2014.01.004. Epub 2014 Jan 13.

DOI:10.1016/j.jcrc.2014.01.004

PMID:24529985

Abstract

BACKGROUND

Staff coverage strategies of intensive care units (ICUs) impact clinical outcomes. High-intensity staff coverage strategies are associated with lower morbidity and mortality. Accessible clinical expertise, team work, and effective communication have all been attributed to the success of this coverage strategy. We evaluate the impact of in-hospital fellow coverage (IHFC) on improving communication of cardiorespiratory events.

METHODS

A prospective observational study performed in an academic tertiary care center with high-intensity staff coverage. The main outcome measure was resident to fellow communication of cardiorespiratory events during IHFC vs home coverage (HC) periods.

RESULTS

Three hundred twelve cardiorespiratory events were collected in 114 surgical ICU patients in 134 study days. Complete data were available for 306 events. One hundred three communication errors occurred. IHFC was associated with significantly better communication of events compared to HC (P<.0001). Residents communicated 89% of events during IHFC vs 51% of events during HC (P<.001). Communication patterns of junior and midlevel residents were similar. Midlevel residents communicated 68% of all on-call events (87% IHFC vs 50% HC, P<.001). Junior residents communicated 66% of events (94% IHFC vs 52% HC, P<.001). Communication errors were lower in all ICUs during IHFC (P<.001).

CONCLUSIONS

IHFC reduced communication errors.

摘要

背景

重症监护病房（ICU）的人员配备策略会影响临床结果。高强度人员配备策略与较低的发病率和死亡率相关。可获得的临床专业知识、团队合作和有效的沟通都被认为是这种人员配备策略成功的原因。我们评估了院内专科医师值班（IHFC）对改善心肺事件沟通的影响。

方法

在一家实行高强度人员配备的学术三级护理中心进行了一项前瞻性观察研究。主要结局指标是在IHFC期间与家庭值班（HC）期间住院医师与专科医师之间关于心肺事件的沟通情况。

结果

在134个研究日中，对114例外科ICU患者收集了312次心肺事件。306次事件有完整数据。发生了103次沟通错误。与HC相比，IHFC与事件沟通明显更好相关（P<0.0001）。住院医师在IHFC期间沟通了89%的事件，而在HC期间为51%（P<0.001）。初级和中级住院医师的沟通模式相似。中级住院医师沟通了所有值班事件的68%（IHFC期间为87%，HC期间为50%，P<0.001）。初级住院医师沟通了66%的事件（IHFC期间为94%，HC期间为 52%，P<0.001）。在IHFC期间，所有ICU的沟通错误都较少（P<0.001）。