Curtis Olivia, Fisher Rachel
BMJ Qual Improv Rep. 2013 Aug 21;2(1). doi: 10.1136/bmjquality.u697.w971. eCollection 2013.
The GMC states that, 'You must be satisfied that, when you are off duty, suitable arrangements have been made for your patients' medical care…including effective hand-over procedures' [1]. The medical weekend handover system at this tertiary referral centre involved multiple pieces of paper with no clear list of tasks, and no way to identify critically unwell patients. Patients could be missed from the ward round or could be difficult to identify under pressure. The authors felt this process could pose a threat to patient safety so decided to improve it. A questionnaire was distributed to all 11 medical SHOs with 100% response rate. Results showed that 72% thought the process was unstructured, 81% did not think the process was always safe, and 100% thought it could be improved. After discussions with senior medical management and with the approval of the trust audit committee, a new weekend handover proforma was designed, taking into consideration the results and comments from the questionnaire. The new proforma is accessible through a shared drive, which can be accessed by all medical SHOs in the hospital. Each team is able to copy their patients onto the combined ward-based list. There are columns for specific weekend jobs and registrar/SHO reviews. Any potentially unwell patients are highlighted in bold and discussed with the on-call SHO on Friday. All medical SHOs were given a post-implementation questionnaire after the new handover process had been in place for two months. Results of this showed that 100% of SHOs felt an improvement had been made, with 100% stating that the new system was more structured (64% always, 36% most of the time). The SHO's perception of patient safety increased from 81% generally unsafe, to 100% generally safe. The new handover has been well received and supported by the current SHO cohort. Improvements in the structure of handover have been made with perceived improvements in patient safety. Due to the success of the system, the handover proforma is being implemented in the trust's sister hospital.
英国医学总会指出，“你必须确保，在你下班时，已为你的患者安排好适当的医疗护理……包括有效的交接班程序”[1]。这家三级转诊中心的周末医疗交接班系统涉及多张纸张，没有明确的任务清单，也无法识别病情危急的患者。患者可能会在查房时被遗漏，或者在压力下难以被识别。作者认为这个过程可能对患者安全构成威胁，因此决定对其进行改进。向所有11名内科住院医师分发了一份问卷，回复率为100%。结果显示，72%的人认为这个过程缺乏条理，81%的人认为这个过程并非总是安全的，100%的人认为它可以改进。在与高级医疗管理层讨论并获得信托审计委员会批准后，考虑到问卷的结果和意见，设计了一种新的周末交接班表格。新表格可通过共享驱动器访问，医院所有内科住院医师都可以访问。每个团队都能够将自己的患者信息复制到基于病房的综合列表中。有专门用于周末特定工作以及住院总医师/住院医师查房的栏目。任何可能病情不佳的患者都用粗体突出显示，并在周五与值班住院医师讨论。在新的交接班流程实施两个月后，向所有内科住院医师发放了一份实施后问卷。结果显示，100%的住院医师认为有了改进，100%的人表示新系统更有条理（64%的时间一直如此，36%的时间大部分如此）。住院医师对患者安全的认知从普遍认为不安全的81%提高到了普遍认为安全的100%。新的交接班方式受到了当前住院医师群体的好评和支持。交接班的结构得到了改进，患者安全也有了明显改善。由于该系统的成功，交接班表格正在信托机构的姊妹医院实施。
