Piekarski Florian, Kaufmann Jost, Laschat Michael, Böhmer Andreas, Engelhardt Thomas, Wappler Frank
Medical Faculty of Health, Witten/Herdecke University, Witten, Germany.
Department of Pediatric Anesthesiology, Children's Hospital of Cologne, Köln/Cologne, Germany.
Paediatr Anaesth. 2015 Jul;25(7):746-52. doi: 10.1111/pan.12646. Epub 2015 Apr 2.
The quality of anesthetic handovers to postanesthesia care units (PACU) is known to be poor in adults, and only very limited reports are available regarding the quality of handovers in pediatric anesthesia. In particular, it is not known which and in what quality information is communicated. This current study investigated, therefore, the presence of any handover component as well as its consistency in a pediatric postanesthesia care unit.
This prospective observational study evaluated postoperative anesthetic handovers to a pediatric PACU using a detailed checklist, comprising 55 possible items. The main outcome measure was the proportion of information verbally transmitted in relation to the written documentation within the anesthesia record.
Four hundred and forty-three handovers were observed with two handovers excluded due to missing data. Type of surgery (93% [95% CI 91-95]) and any intra-operative regional anesthesia (89% [95% CI 85-94]) were most frequently communicated. Items such as ASA-PS (3% [95% CI 2-5]) and fluid management (4% of cases [95% CI 2-6]) were rarely handed over. Eleven of the 55 items contained within the checklist were communicated in more than 70% of patients.
The observed handovers to PACU staff were incomplete and missing important information. However, omission of essential information potentially compromises patient safety. A standardized universal mandatory handover protocol following pediatric anesthesia is required.
已知成人麻醉后交接至麻醉后护理单元（PACU）的质量较差，而关于小儿麻醉交接质量的报告非常有限。特别是，不清楚交接了哪些信息以及信息的质量如何。因此，本研究调查了小儿麻醉后护理单元中交接内容的存在情况及其一致性。
这项前瞻性观察性研究使用包含55个可能条目的详细检查表，评估了术后麻醉向小儿PACU的交接情况。主要结局指标是麻醉记录中口头传达的信息与书面记录相关的比例。
共观察了443次交接，因数据缺失排除了2次交接。手术类型（93% [95% CI 91 - 95]）和任何术中区域麻醉（89% [95% CI 85 - 94]）的交接最为频繁。美国麻醉医师协会身体状况分级（ASA - PS）（3% [95% CI 2 - 5]）和液体管理（4%的病例 [95% CI 2 - 6]）等项目很少交接。检查表中的55个项目中有11个在超过70%的患者中进行了交接。
观察到向PACU工作人员的交接不完整且缺少重要信息。然而，遗漏重要信息可能会危及患者安全。小儿麻醉后需要一个标准化的通用强制性交接方案。
