Ahluwalia Nikhil
BMJ Qual Improv Rep. 2013 Aug 21;2(1). doi: 10.1136/bmjquality.u202048.w1055. eCollection 2013.
A significant amount of professional time is wasted during a medical ward round retrieving patient notes from the ward trolley. If the efficiency of this non-clinical, non-functional interaction could be improved it would save time, maintain continuity and have financial implications. One identified constraint was the structure of the traditional ward trolley; a stationary filing tray with vertical sleeves. During ward round, time is spent returning and retrieving each patients notes from outside the patient bay and additional time may be wasted if the notes are misplaced or in use elsewhere. To resolve this, the 'Vista 90' trolley with horizontal, transparent trays, is portable and has an ergonomic writing surface was selected as a potential second generation replacement. An assessment of the impact of the Vista 90 trolley over the traditional trolley in the clinical setting was carried out on Erringham (medical) Ward, Worthing Hospital, West Sussex Hospital Trust, UK. This was by way of qualitative analysis performed by semi-structured interview of 12 doctors and other healthcare professionals who regularly interacted with the Vista 90 and traditional trolley in December 2012. The audit found that those interviewed preferred using the Vista 90 trolley over its predecessor as it improved the efficiency of the ward round and subsequent clinical work. It's mobility allowed it to be easily transported with the ward round, reducing disruption during a consultation and between consecutives ones. The ergonomic writing surface was noted to improve legibility of documentation due to greater comfort and if placed appropriately, did not interfere with the doctor-patient interaction. The financial savings of this greater efficiency was found to be of significance and justify the cost of the Vista 90 within two weeks.
在医疗查房过程中,从病房推车上取回患者病历会浪费大量的专业时间。如果能提高这种非临床、无功能性互动的效率,就能节省时间、保持连续性并产生财务影响。一个已确定的制约因素是传统病房推车的结构,即带有垂直套筒的固定文件托盘。在查房期间,要花费时间从病房外归还和取回每位患者的病历,如果病历放错位置或在其他地方被使用,还可能浪费额外的时间。为了解决这个问题,选择了带有水平透明托盘、便于携带且有符合人体工程学书写表面的“Vista 90”推车作为潜在的第二代替代品。英国西苏塞克斯医院信托基金沃辛医院埃林厄姆(内科)病房对Vista 90推车在临床环境中相对于传统推车的影响进行了评估。这是通过对12名医生和其他医疗专业人员进行半结构化访谈进行定性分析的方式进行的,这些人员在2012年12月经常与Vista 90推车和传统推车进行互动。审计发现,接受采访的人员更喜欢使用Vista 90推车而不是其前身,因为它提高了查房及后续临床工作的效率。它的可移动性使其能够在查房时轻松运输,减少会诊期间及连续会诊之间的干扰。由于更加舒适,符合人体工程学的书写表面被认为提高了文件记录的清晰度,并且如果放置得当,不会干扰医患互动。发现这种更高效率所节省的资金具有重要意义,足以在两周内证明Vista 90的成本是合理的。