Kessler Chad, Scott Nathaniel L, Siedsma Matt, Jordan Jaime, Beach Christopher, Coletti Christian M
Durham VA Medical Center and Duke University School of Medicine, Durham, NC.
Hennepin County Medical Center, Departments of Emergency Medicine and Internal Medicine, and the University of Minnesota Medical School, Minneapolis, MN.
Ann Emerg Med. 2014 Oct;64(4):343-349.e5. doi: 10.1016/j.annemergmed.2014.04.022. Epub 2014 Jun 6.
We describe the current state of emergency department to inpatient handoffs and assess handoff best practices between emergency physicians and hospitalist medicine physicians.
A survey was distributed electronically to emergency medicine and internal medicine physicians at 10 hospitals across the United States. Descriptive and quantitative analysis was performed on survey results. Additionally, qualitative data were obtained from an expert focus group of both emergency medicine and hospital medicine clinicians.
Seven hundred fifty of 1,799 physicians (42.2%) responded to our Web-based survey. Attending physicians (45%) described themselves as practicing emergency medicine (51%) or internal medicine (56%). Responding residents were 55% internal medicine, 43% emergency medicine, and 13% dual emergency medicine/internal medicine. Of the responding departments, use of standardized tools was reported by less than 20% and only one third of residents reported formal handoff training. Handoff factors identified as important include identifying "high-risk" patients, designating uninterrupted time to perform the handoff, and standardizing information provided during the handoff. Qualitative results mirrored these themes and acknowledged the importance of bedside handoffs.
To our knowledge, this is the largest multispecialty survey to date, including both resident and attending physicians in emergency medicine and hospital medicine. Standardized tools are rarely used and training of residents in this critical task is uncommon. Physicians in both specialties agree on the important content and structure of handoff, including the ideal situation of face-to-face bedside discussion. A curriculum and assessment tool for this practice should be developed.
我们描述了急诊科向住院部交接患者的当前状况，并评估了急诊医生与内科住院医生之间交接的最佳实践。
通过电子方式向美国10家医院的急诊医学和内科医生发放了一份调查问卷。对调查结果进行了描述性和定量分析。此外，从急诊医学和医院医学临床医生的专家焦点小组中获取了定性数据。
1799名医生中有750名（42.2%）回复了我们基于网络的调查。主治医生（45%）称自己从事急诊医学（51%）或内科（56%）。回复问卷的住院医生中，55%是内科医生，43%是急诊医生，13%是急诊医学/内科双专业医生。在回复的科室中，报告使用标准化工具的不到20%，只有三分之一的住院医生报告接受过正式的交接培训。被认为重要的交接因素包括识别“高危”患者、指定不间断的交接时间以及规范交接过程中提供的信息。定性结果反映了这些主题，并认可了床边交接的重要性。
据我们所知，这是迄今为止规模最大的多专业调查，涵盖了急诊医学和医院医学的住院医生和主治医生。标准化工具很少使用，对住院医生进行这项关键任务的培训也不常见。两个专业的医生在交接的重要内容和结构上达成了一致，包括面对面床边讨论的理想情况。应该开发针对这种实践的课程和评估工具。
