Indiana University School of Medicine, Indianapolis, Indiana, USA Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.
Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.
BMJ Qual Saf. 2016 Feb;25(2):76-83. doi: 10.1136/bmjqs-2014-003853. Epub 2015 Jul 27.
Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood.
To investigate questions and the functions they serve in nursing and medicine handoffs.
Qualitative thematic analysis based on audio recordings of nurse-to-nurse, medical resident-to-resident and surgical intern-to-intern handoffs.
Twenty-seven nurse handoff dyads and 18 medical resident and surgical intern handoff dyads at one VA Medical Center.
Our analysis revealed that the vast majority of questions were asked by the Incoming Providers. Although topics varied widely, the bulk of Incoming Provider questions requested information that would best help them understand individual patient conditions and plan accordingly. Other question types sought consensus on clinical reasoning or framing and alignment between the two professionals.
Handoffs are a type of socially constructed work. Questions emerge with some frequency in virtually all handoffs but not in a linear or predictable way. Instead, they arise in the moment, as necessary, and without preplanning. A checklist cannot model this process element because it is a static memory aid and questions occur in a relational context that is emergent. Studying the different functions of questions during end of shift handoffs provides insights into the interface between the technical context in which information is transferred and the social context in which meaning is created.
交接班是医疗质量、安全和结果的一个脆弱环节，这是众所周知的。尽管为了提高交接班的可靠性做出了许多努力，但很少有干预措施能产生持久的改变。尽管一些监管机构要求在患者交接班时有机会提问，但对交接班时提问的作用还没有进行充分的探索和理解。
调查护理和医疗交接班中提问的类型和作用。
基于对 VA 医疗中心的 27 对护士交接班、18 对医学生和实习医生交接班的音频记录进行定性主题分析。
27 对护士交接班搭档和 18 对医学生和实习医生交接班搭档。
我们的分析显示，绝大多数问题都是由新接班的医护人员提出的。尽管主题各不相同，但新接班医护人员的大部分问题都是在请求有助于他们了解个别患者病情并相应地做出计划的信息。其他类型的问题则是寻求对临床推理或框架的共识，并在两位专业人员之间达成一致。
交接班是一种社会构建的工作。几乎所有的交接班中都会出现一些问题，但不是以线性或可预测的方式出现。相反，它们是在需要的时候出现的，没有预先计划。清单不能模拟这个过程要素，因为它是一个静态的记忆辅助工具，而问题是在一个涌现的关系背景中出现的。研究交接班时不同类型的问题可以深入了解信息传递的技术背景和意义创造的社会背景之间的接口。
