Gonzalo Jed D, Yang Julius J, Stuckey Heather L, Fischer Christopher M, Sanchez Leon D, Herzig Shoshana J
Assistant Professor of Medicine and Public Health Sciences, Assistant Dean for Health Systems Education, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
Director of Inpatient Quality, Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, and Assistant Professor, Harvard Medical School, Boston, Massachusetts.
Int J Qual Health Care. 2014 Aug;26(4):337-47. doi: 10.1093/intqhc/mzu040. Epub 2014 Apr 15.
To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period.
Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation.
University-based, tertiary-care hospital.
Internal medicine resident physicians admitting patients from the emergency department.
An electronic handoff tool (eSignout) utilizing automated paging communication and responsibility acceptance without mandatory verbal communication between emergency department and medicine ward providers.
(i) Incidence of reported near misses/adverse events, (ii) communication of key clinical information and quality of verbal communication and (iii) characterization of near misses/adverse events.
Seventy-eight of 80 surveys (98%) and 1058 of 1388 surveys (76%) were completed before and after eSignout implementation. Compared with pre-intervention, residents in the post-intervention period reported similar number of shifts with a near miss/adverse event (10.3 vs. 7.8%; P = 0.27), similar communication of key clinical information, and improved verbal signout quality, when it occurred. Compared with the former process requiring mandatory verbal communication, 93% believed the eSignout was more efficient and 61% preferred the eSignout. Patient safety issues related to perceived sufficiency/accuracy of diagnosis, treatment or disposition, and information quality.
The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs.
评估一种新型电子交接工具在1年时间内对急诊科向内科病房患者转运的影响。
对实施电子签出前后内科住院医师在接收班次后提交的数据进行前瞻性混合方法分析。
大学附属的三级护理医院。
接收来自急诊科患者的内科住院医师。
一种电子交接工具（电子签出），利用自动寻呼通信和责任确认，急诊科和内科病房医护人员之间无需进行强制性口头沟通。
（i）报告的险些发生的失误/不良事件的发生率，（ii）关键临床信息的沟通及口头沟通质量，以及（iii）险些发生的失误/不良事件的特征。
在电子签出实施前和实施后，分别完成了80份调查问卷中的78份（98%）和1388份调查问卷中的1058份（76%）。与干预前相比，干预后住院医师报告的发生险些发生的失误/不良事件的班次数量相似（10.3%对7.8%；P = 0.27），关键临床信息的沟通情况相似，口头签出质量有所改善（如果发生口头签出）。与之前要求强制性口头沟通的流程相比，93%的人认为电子签出更高效，61%的人更喜欢电子签出。患者安全问题与诊断、治疗或处置的充分性/准确性以及信息质量有关。
与强制性口头签出流程相比，电子签出被认为更高效且更受青睐。干预前后报告的不良事件发生率相似。我们的经验表明，具有可选口头沟通功能的电子平台可用于规范并提高患者交接的感知效率。
