Donnelly Michael J, Clauser Janelle M, Tractenberg Rochelle E
J Grad Med Educ. 2014 Mar;6(1):112-6. doi: 10.4300/JGME-D-13-00139.1.
Graduating residents transition their continuity clinic patients to junior colleagues every year, creating a vulnerable transition period for about 1 million patients nationally.
We examined a standardized, electronic template for handing off high-risk ambulatory patients by outgoing residents from 7 residencies within a large health care system, and compared handoff quantity and provider satisfaction for handoffs with and without that template.
Residents graduating in 2011 from 5 internal medicine, 1 family medicine, and 1 internal medicine-pediatrics residency programs in 1 health care system were randomized to a new electronic handoff process with a standardized intervention template or a free-text handoff. Expert reviewers independently evaluated all handoff notes, and providers were surveyed after follow-up appointments regarding use, helpfulness, and overall satisfaction with the handoffs.
Fifty-two of 79 residents (66%) participated, performing 278 handoffs. Eighty-four patients (30%, 17 of 57) failed to follow up within the study period. For patients who followed up, providers read 61% (101 of 165) of the handoffs at the time of the visit. No significant difference existed between groups in the satisfaction of the follow up provider or the quality measure of the handoffs in our process. Expert agreement on which features make the handoff "helpful" was fair (κ = 0.34).
A standardized template did not improve handoff quantity or satisfaction compared with a free-text handoff. Practical handoff programs can be instituted into diverse residencies within a short time frame, with most residents taking part in creating the handoff formats.
即将毕业的住院医师每年都会将其连续性门诊的患者交接给年轻的同事，这在全国范围内为约100万患者创造了一个脆弱的过渡期。
我们研究了一种标准化的电子模板，用于大型医疗系统内7个住院医师培训项目中即将离职的住院医师交接高危门诊患者的情况，并比较了使用该模板和不使用该模板时的交接数量及提供者满意度。
2011年从一个医疗系统内的5个内科、1个家庭医学和1个内科-儿科住院医师培训项目毕业的住院医师被随机分配到采用标准化干预模板的新电子交接流程或自由文本交接流程。专家评审员独立评估所有交接记录，并在随访预约后对提供者就交接的使用情况、有用性及总体满意度进行调查。
79名住院医师中有52名（66%）参与，进行了278次交接。84名患者（30%，57名中的17名）在研究期间未进行随访。对于进行随访的患者，提供者在就诊时阅读了61%（165份中的101份）的交接记录。在我们的流程中，两组在随访提供者的满意度或交接的质量指标方面没有显著差异。关于哪些特征使交接“有用”的专家共识一般（κ = 0.34）。
与自由文本交接相比，标准化模板并未提高交接数量或满意度。实用的交接项目可在短时间内引入不同的住院医师培训项目，大多数住院医师会参与创建交接格式。
