Sujan Mark A, Chessum Peter, Rudd Michelle, Fitton Laurence, Inada-Kim Matthew, Cooke Matthew W, Spurgeon Peter
Associate Professor of Patient Safety, Warwick Medical School, University of Warwick, UK
Lead Advanced Clinical Practitioner, Heart of England NHS Foundation Trust, UK.
J Health Serv Res Policy. 2015 Jan;20(1 Suppl):17-25. doi: 10.1177/1355819614560449.
Handover across care boundaries poses additional challenges due to the different professional, organizational and cultural backgrounds of the participants involved. This paper provides a qualitative account of how practitioners in emergency care attempt to align their different individual and organizational priorities and backgrounds when handing over patients across care boundaries (ambulance service to emergency department (ED), and ED to acute medicine).
A total of 270 clinical handovers were observed in three emergency care pathways involving five participating NHS organizations (two ambulance services and three hospitals). Half-day process mapping sessions were conducted for each pathway. Semi-structured interviews were carried out with 39 participants and analysed thematically.
The management of patient flow and the fulfilment of time-related performance targets can create conflicting priorities for practitioners during handover. Practitioners involved in handover manage such competing organizational priorities through additional coordination effort and dynamic trade-offs. Practitioners perceive greater collaboration across departments and organizations, and mutual awareness of each other's goals and constraints as possible ways towards more sustainable improvement.
Sustainable improvement in handover across boundaries in emergency care might require commitment by leaders from all parts of the local health economy to work as partners to establish a culture of integrated, patient-centred care.
由于参与交接的各方人员有着不同的专业、组织和文化背景，跨医疗边界的交接带来了额外的挑战。本文对急救护理人员在跨医疗边界（从救护车服务到急诊科（ED），以及从ED到急性医学科）交接患者时，如何尝试协调他们不同的个人和组织优先事项及背景进行了定性描述。
在涉及五个参与的英国国民健康保险制度（NHS）组织（两个救护车服务机构和三家医院）的三条急救护理路径中，共观察了270次临床交接。为每条路径进行了半天的流程映射会议。对39名参与者进行了半结构化访谈，并进行了主题分析。
患者流程管理和与时间相关的绩效目标的实现，可能会在交接过程中给医护人员带来相互冲突的优先事项。参与交接的医护人员通过额外的协调努力和动态权衡来管理这些相互竞争的组织优先事项。医护人员认为，跨部门和组织的更多合作，以及对彼此目标和限制的相互了解，是实现更可持续改进的可能途径。
急救护理中跨边界交接的可持续改进，可能需要当地卫生经济各部门的领导者作为合作伙伴共同努力，以建立一种以患者为中心的综合护理文化。
