Palmer Edward, Richardson Emma, Newcombe Hannah, Borg Cynthia-Michelle
Lewisham Healthcare NHS Trust.
BMJ Qual Improv Rep. 2013 Nov 29;2(2). doi: 10.1136/bmjquality.u660.w502. eCollection 2014.
There is a higher incidence of mortality and adverse events among inpatients in UK hospitals at the weekend compared to weekdays. The high volume of routine tasks handed over by the weekday doctors on Fridays may be a contributing factor. An audit was carried out on four acute wards on a Friday evening at University Hospital Lewisham (UHL). It demonstrated that most patients had at least one outstanding task that would need completing by the on-call team over the weekend. To address this problem a concise and memorable checklist was created to ensure that routine jobs are completed by the weekday team prior to the weekend. The checklist uses the acronym "F.R.I.D.A.Y.S." to prompt doctors to hand over weekend bloods, ensure drug charts are reviewed, document a plan for IV fluids, complete discharge summaries, monitor antibiotic levels, dose warfarin, and clearly document the ceiling of care. The F.R.I.D.A.Y.S. checklist was printed onto history paper and integrated into the patient notes on a Friday ward round. The efficacy of the checklist was evaluated by reviewing the number of outstanding jobs on the wards after 17:00 on a Friday in the categories listed. F-Phlebotomy R-Rewrite drug chart I-IV fluids D-Discharge summaries A-Antibiotic levels Y-Yellow book (warfarin) S-Resuscitation Status The number of outstanding jobs on a ward (A) that used F.R.I.D.A.Y.S. was 3 out of a total 132 jobs (2.3%) compared with 47 out of a total of 103 (45.6%) on a ward that did not use the checklist (B). When the F.R.I.D.A.Y.S. checklist is implemented there is an increase in the number of routine jobs that are carried out by the weekday team, and therefore a reduction in workload for the weekend on call team. Patient safety is improved as management decisions are made by a team that is familiar with the patient, and on call teams are able to prioritise emergencies. The cost saving of using the F.R.I.D.A.Y.S. checklist if implemented throughout UHL is estimated at £317,136 per annum.
与工作日相比，英国医院周末住院患者的死亡率和不良事件发生率更高。周五工作日医生移交的大量日常任务可能是一个促成因素。在刘易舍姆大学医院（UHL）的一个周五晚上，对四个急症病房进行了一次审计。结果表明，大多数患者至少有一项未完成的任务，需要周末值班团队来完成。为了解决这个问题，创建了一个简洁易记的清单，以确保日常工作在周末前由工作日团队完成。该清单使用首字母缩写“F.R.I.D.A.Y.S.”来提示医生移交周末的血液检查、确保审查药物图表、记录静脉输液计划、完成出院小结、监测抗生素水平、调整华法林剂量，并明确记录护理上限。F.R.I.D.A.Y.S.清单打印在病历纸上，并在周五的病房查房时整合到患者病历中。通过审查周五17:00后病房中所列类别中未完成工作的数量，对该清单的效果进行了评估。F-静脉采血；R-重写药物图表；I-静脉输液；D-出院小结；A-抗生素水平；Y-黄皮书（华法林）；S-复苏状态。使用F.R.I.D.A.Y.S.清单的病房（A）未完成工作的数量在总共132项工作中为3项（2.3%），而未使用该清单的病房（B）在总共103项工作中有47项（45.6%）。当实施F.R.I.D.A.Y.S.清单时，工作日团队完成的日常工作数量增加，因此周末值班团队的工作量减少。由于管理决策由熟悉患者的团队做出，患者安全得到改善，值班团队能够优先处理紧急情况。如果在整个UHL实施F.R.I.D.A.Y.S.清单，估计每年可节省成本317,136英镑。
