Zakrison Tanya Liv, Rosenbloom Brittany, McFarlan Amanda, Jovicic Aleksandra, Soklaridis Sophie, Allen Casey, Schulman Carl, Namias Nicholas, Rizoli Sandro
Department of Surgery, University of Miami, Miami, Florida, USA.
Faculty of Medicine, Institute of Medical Sciences, Toronto, Ontario, Canada.
BMJ Qual Saf. 2016 Dec;25(12):929-936. doi: 10.1136/bmjqs-2014-003903. Epub 2015 Nov 6.
Clinical information may be lost during the transfer of critically injured trauma patients from the emergency department (ED) to the intensive care unit (ICU). The aim of this study was to investigate the causes and frequency of information discrepancies with handover and to explore solutions to improving information transfer.
A mixed-methods research approach was used at our level I trauma centre. Information discrepancies between the ED and the ICU were measured using chart audits. Descriptive, parametric and non-parametric statistics were applied, as appropriate. Six focus groups of 46 ED and ICU nurses and nine individual interviews of trauma team leaders were conducted to explore solutions to improve information transfer using thematic analysis.
Chart audits demonstrated that injuries were missed in 24% of patients. Clinical information discrepancies occurred in 48% of patients. Patients with these discrepancies were more likely to have unknown medical histories (p<0.001) requiring information rescue (p<0.005). Close to one in three patients with information rescue had a change in clinical management (p<0.01). Participants identified challenges according to their disciplines, with some overlap. Physicians, in contrast to nurses, were perceived as less aware of interdisciplinary stress and their role regarding variability in handover. Standardising handover, increasing non-technical physician training and understanding unit cultures were proposed as solutions, with nurses as drivers of a culture of safety.
Trauma patient information was lost during handover from the ED to the ICU for multiple reasons. An interprofessional approach was proposed to improve handover through cross-unit familiarisation and use of communication tools is proposed. Going beyond traditional geographical and temporal boundaries was deemed important for improving patient safety during the ED to ICU handover.
在重伤创伤患者从急诊科（ED）转至重症监护病房（ICU）的过程中，临床信息可能会丢失。本研究的目的是调查交接时信息差异的原因及频率，并探索改善信息传递的解决方案。
在我们的一级创伤中心采用了混合方法研究。通过病历审核来衡量急诊科和重症监护病房之间的信息差异。酌情应用描述性、参数和非参数统计方法。进行了6个焦点小组讨论，涉及46名急诊科和重症监护病房护士，以及对创伤团队负责人进行了9次个人访谈，以通过主题分析探索改善信息传递的解决方案。
病历审核表明，24%的患者存在损伤漏诊情况。48%的患者出现临床信息差异。存在这些差异的患者更有可能有未知病史（p<0.001），需要进行信息补救（p<0.005）。近三分之一接受信息补救的患者临床管理发生了变化（p<0.01）。参与者根据各自的专业领域确定了挑战，存在一些重叠。与护士相比，医生被认为对跨学科压力及其在交接变异性方面的作用了解较少。提出将交接标准化、增加医生的非技术培训以及了解科室文化作为解决方案，以护士作为安全文化的推动者。
由于多种原因，创伤患者在从急诊科转至重症监护病房的交接过程中信息丢失。建议采用跨专业方法，通过跨科室熟悉和使用沟通工具来改善交接。超越传统的地理和时间界限被认为对于改善急诊科到重症监护病房交接期间的患者安全很重要。
