Higgins Alanna, Brannen Melissa L, Heiman Heather L, Adler Mark D
From the *Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois; †Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania; and ‡Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Patient Saf. 2017 Jun;13(2):88-92. doi: 10.1097/PTS.0000000000000126.
Studies show singular handoffs between health care providers to be risky. Few describe sequential handoffs or compare handoffs from different provider types. We investigated the transfer of information across 2 handoffs using a piloted survey instrument. We compared cross-cover (every fourth night call) with dedicated night-shift residents.
Surveys assessing provider knowledge of hospitalized patients were administered to pediatric residents. Primary teams were surveyed about their handoff upon completion of daytime coverage of a patient. Night-shift or cross-covering residents were surveyed about their handoff of the same patient upon completion of overnight coverage. Pediatric hospitalists rated the consistency of information between the surveys. Absolute difference was calculated between the 2 providers' rating of a patient's (a) complexity and (b) illness severity. Scores were compared across provider type.
Fifty-nine complete handoff pairs were obtained. Fourteen and 45 handoff surveys were completed by a cross-covering and a night-shift provider, respectively. There was no significant difference in information consistency between primary and night-shift (median, 4.0; interquartile range [IQR], 3-4) versus primary and cross-covering providers (median, 4.0; IQR, 3-4). There was no significant difference in median patient complexity ratings (night shift, 3.0; IQR, 1-5, versus cross cover, 3.5; IQR, 1-5) or illness severity ratings (night shift, 2.0; IQR, 1-4, versus cross-cover, 3.0; IQR, 1-6) when comparing provider types giving a handoff.
We did not find a difference in physicians' transfer of information during 2 handoffs among providers taking traditional call or on night shift. Development of tools to measure handoff consistency is needed.
研究表明医疗服务提供者之间的单次交接班存在风险。很少有研究描述连续交接班情况或比较不同类型提供者之间的交接班。我们使用一种经过试点的调查工具，调查了两次交接班过程中的信息传递情况。我们比较了交叉值班（每隔四个夜班呼叫）与专职夜班住院医师的情况。
对儿科住院医师进行了评估其对住院患者了解程度的调查。在负责患者白天护理的主要团队完成交接班后对其进行调查。在负责同一患者夜间护理的夜班或交叉值班住院医师完成交接班后对其进行调查。儿科住院医师对两次调查之间信息的一致性进行评分。计算两位提供者对患者（a）病情复杂性和（b）疾病严重程度评分的绝对差值。比较不同类型提供者的得分。
共获得59对完整的交接班数据。交叉值班提供者和夜班提供者分别完成了14次和45次交接班调查。主要团队与夜班提供者（中位数为4.0；四分位间距[IQR]为3 - 4）以及主要团队与交叉值班提供者（中位数为4.0；IQR为3 - 4）之间的信息一致性没有显著差异。在比较进行交接班的不同类型提供者时，患者病情复杂性评分中位数（夜班为3.0；IQR为1 - 5，交叉值班为3.5；IQR为1 - 5）或疾病严重程度评分中位数（夜班为2.0；IQR为1 - 4，交叉值班为3.0；IQR为1 - 6）没有显著差异。
我们发现在进行传统呼叫或夜班的提供者之间的两次交接班过程中，医生的信息传递没有差异。需要开发衡量交接班一致性的工具。
