Mehra Avi, Henein Christin
Brighton & Sussex University Hospitals NHS Trust.
BMJ Qual Improv Rep. 2014 Feb 4;2(2). doi: 10.1136/bmjquality.u202861.w1655. eCollection 2014.
Clinical Handover remains one of the most perilous procedures in medicine (1). Weekend handover has emerged as a key area of concern with high variability in handover processes across hospitals (1,2,4, 5-10). Studying weekend handover processes within medicine at an acute teaching hospital revealed huge variability in documented content and structure. A total of 12 different pro formas were in use by the medical day-team to handover to the weekend team on-call. A Likert-survey of doctors revealed 93% felt the current handover system needed improvement with 71% stating that it did not ensure patient safety (Chi-squared, p-value <0.001, n=32). Semi-structured interviews of doctors identified common themes including "a lack of consistency in approach" "poor standardization" and "high variability". Seeking to address concerns of standardization, a standardized handover pro forma was developed using Royal College of Physician (RCP) guidelines (2), with direct end-user input. Results following implementation revealed a considerable improvement in documented ceiling of care, urgency of task and team member assignment with 100% uptake of the new proforma at both 4-week and 6-month post-implementation analyses. 88% of doctors surveyed perceived that the new proforma improved patient safety (p<0.01, n=25), with 62% highlighting that it allowed doctors to work more efficiently. Results also revealed that 44% felt further improvements were needed and highlighted electronic solutions and handover training as main priorities. Handover briefing was subsequently incorporated into junior doctor induction and education modules delivered, with good feedback. Following collaboration with key stakeholders and with end-user input, integrated electronic handover software was designed and funding secured. The software is currently under final development. Introducing a standardized handover proforma can be an effective initial step in improving weekend handover. Handover education and end-user involvement are key in improving the process. Electronic handover solutions have been shown to significantly increase the quality of handover and are worth considering (9, 10).
临床交接班仍然是医疗领域最具风险的操作之一(1)。周末交接班已成为一个关键的关注领域，各医院的交接班流程差异很大(1,2,4,5 - 10)。对一家急症教学医院内科的周末交接班流程进行研究发现，记录内容和结构存在巨大差异。内科日间团队在向周末值班团队交接班时，总共使用了12种不同的交接表。一项针对医生的李克特量表调查显示，93%的医生认为当前的交接班系统需要改进，71%的医生表示该系统不能确保患者安全(卡方检验，p值<0.001，n = 32)。对医生进行的半结构化访谈确定了一些共同主题，包括“方法缺乏一致性”“标准化程度低”和“差异大”。为了解决标准化问题，根据皇家内科医师学院(RCP)的指南(2)，在终端用户的直接参与下，制定了一份标准化的交接表。实施后的结果显示，在记录的护理上限、任务紧迫性和团队成员分配方面有了显著改善，在实施后4周和6个月的分析中，新交接表的采用率均为100%。88%接受调查的医生认为新交接表提高了患者安全(p<0.01，n = 25)，62%的医生强调它使医生能够更高效地工作。结果还显示，44%的医生认为需要进一步改进，并强调电子解决方案和交接班培训是主要优先事项。随后，交接班简报被纳入初级医生入职培训和教育模块，并获得了良好的反馈。在与关键利益相关者合作并得到终端用户的参与后，设计了集成电子交接班软件并获得了资金。该软件目前正在进行最后的开发。引入标准化的交接表可能是改善周末交接班的有效第一步。交接班教育和终端用户的参与是改进这一流程的关键。电子交接班解决方案已被证明能显著提高交接班质量，值得考虑(9,10)。
