Estryn-Behar Madeleine R, Milanini-Magny Giuliana, Chaumon Elise, Deslandes Hélène, Fry Clementine, Garcia Frederic, Ravache Anne-Emilie
From the Service central de Médecine du travail de l'AP-HP, Hôtel-Dieu, Paris, France.
J Patient Saf. 2014 Mar;10(1):29-44. doi: 10.1097/PTS.0000000000000066.
Two statistical surveys in France revealed both widespread dissatisfaction about shift change handovers and the feeling of being frequently disturbed by interruptions. Shift change handovers (SCHs) are being reduced or eliminated in France to reduce staff costs. The objective of our study is to clarify the consequences of short SCHs on efficiency, team function, and quality of care.
Real-time task ergonomic analysis of 29 state-registered nurses (RNs), 18 nursing aides (NAs), and 14 full-time physicians was conducted in various departments of general and university hospitals.
The average time available to RNs for sharing information during SCHs was 15 minutes at the beginning of the work session and 13 minutes at the end. There were, on average, 50 interruptions of activity, and these interruptions occupied 16% of the working time. Consequently, less time was available for direct care, although the number of such acts was increased. Periods for preparation of care, writing, seeking information, or equipment were very numerous. The mean number of changes of activity was very large: 260 per work session. For NAs, SCHs were similar to those for RNs at the beginning of the work session (mean = 18 minutes) but shorter at the end (10 minutes). The mean number of interruptions was 30 and caused 10.3% of the working time to be lost with 164 changes of activity. For physicians, SCHs were even shorter and, in many cases, nonexistent. The mean number of interruptions was 30 (11.4% of their working time, 153 changes of activity). Shift change handovers were mostly conducted separately for RNs, NAs, and physicians.
A better sharing of knowledge between the different health-care workers, and especially at the beginning of the work session, could reduce interruptions and potentially improve quality of care.
法国的两项统计调查显示，医护人员对交接班普遍不满，且经常感到被打断工作。为降低员工成本，法国正在减少或取消交接班。我们研究的目的是阐明缩短交接班时间对效率、团队功能和护理质量的影响。
对29名注册护士、18名护理助理和14名全职医生在综合医院和大学医院的各个科室进行实时任务工效学分析。
注册护士在交接班期间用于信息共享的平均时间，在工作时段开始时为15分钟，结束时为13分钟。平均有50次活动中断，这些中断占用了16%的工作时间。因此，尽管直接护理行为的数量有所增加，但用于直接护理的时间却减少了。护理准备、书写、信息查询或设备准备的时间段非常多。每次工作时段的平均活动变化次数非常多：260次。对于护理助理，交接班在工作时段开始时与注册护士相似（平均18分钟），但结束时较短（10分钟）。平均中断次数为30次，导致10.3%的工作时间流失，活动变化164次。对于医生，交接班时间更短，在很多情况下甚至不存在。平均中断次数为30次（占其工作时间的11.4%，活动变化153次）。护士、护理助理和医生的交接班大多是分开进行的。
不同医护人员之间更好地共享知识，尤其是在工作时段开始时，可能会减少中断，并有可能提高护理质量。
