Garg Trit, Lee Jonathan Y, Evans Kambria H, Chen Jonathan, Shieh Lisa
Stanford Graduate School of Business, Stanford, California, USA.
Jt Comm J Qual Patient Saf. 2015 Mar;41(3):126-31. doi: 10.1016/s1553-7250(15)41017-7.
Checklists may help reduce discharge errors; however, current paper checklists have limited functionality. In 2013 a best-practice discharge checklist using the electronic health record (EHR) was developed and evaluated at Stanford University Medical Center (Stanford, California) in a cluster randomized trial to evaluate its usage, user satisfaction, and impact on physicians' work flow.
The study was divided into four phases.
In Phase I, on the survey (N = 76), most of the participants (54.0%) reported using memory to remember discharge tasks. On a 0-100 scale, perception of checklists as being useful was strong (mean, 66.4; standard deviation [SD], 21.2), as was interest in EHR checklists (64.5, 26.6). In Phase II, the checklist consisted of 15 tasks categorized by admission, hospitalization, and discharge-planning. In Phase III, the checklist was implemented as an EHR "smart-phrase" allowing for automatic insertion. In Phase IV, in a trial with 60 participating physicians, 23 EHR checklist users reported higher usage than 12 paper users (28.5 versus 7.67, p = .019), as well as higher checklist integration with work flow (22.6 versus 1.67, p = .014), usefulness of checklist (33.7 versus. 8.92, p = .041), discharge confidence (30.8 versus 5.00, p = .029), and discharge efficiency (25.5 versus 6.67, p = .056). Increasing EHR checklist use was correlated with usefulness ( r = .85, p < .001), confidence (r = .81, p < .001), and efficiency (r = .87, p < .001).
The EHR checklist reminded physicians to complete discharge tasks, improved confidence, and increased process efficiency. This is the first study to show that medicine residents use "memory" as the most common method for remembering discharge tasks. These data reinforce the need for a formalized tool, such as a checklist, that residents can rely on to complete important discharge tasks.
清单可能有助于减少出院错误；然而，目前的纸质清单功能有限。2013年，斯坦福大学医学中心（加利福尼亚州斯坦福）开发并在一项整群随机试验中评估了一种使用电子健康记录（EHR）的最佳实践出院清单，以评估其使用情况、用户满意度以及对医生工作流程的影响。
该研究分为四个阶段。
在第一阶段，在调查中（N = 76），大多数参与者（54.0%）报告使用记忆来记住出院任务。在0至100的量表上，对清单有用性的感知很强（均值为66.4；标准差[SD]为21.2），对电子健康记录清单的兴趣也很强（64.5，26.6）。在第二阶段，清单由15项任务组成，按入院、住院和出院计划进行分类。在第三阶段，清单作为一个电子健康记录“智能短语”实施，允许自动插入。在第四阶段，在一项有60名参与医生的试验中，23名电子健康记录清单用户报告的使用频率高于12名纸质清单用户（28.5对7.67，p = 0.019），清单与工作流程的整合度也更高（22.6对1.67，p = 0.014），清单的有用性更高（33.7对8.92，p = 0.041），出院信心更强（30.8对5.00，p = 0.029），出院效率更高（25.5对6.67，p = 0.056）。电子健康记录清单使用的增加与有用性（r = 0.85，p < 0.001）、信心（r = 0.81，p < 0.001）和效率（r = 0.87，p < 0.001）相关。
电子健康记录清单提醒医生完成出院任务，提高了信心，并提高了流程效率。这是第一项表明住院医师将“记忆”作为记住出院任务最常用方法的研究。这些数据强化了对一种正式工具（如清单）的需求，住院医师可以依靠它来完成重要的出院任务。
