Ah-Kye Laura, Moore Madeline
King's College Hospital, UK.
BMJ Qual Improv Rep. 2015 Dec 1;4(1). doi: 10.1136/bmjquality.u205385.w4127. eCollection 2015.
The General Medical Council (GMC) states, "A well managed, thorough and organized handover is crucial for ensuring the quality and safety for patient care," and in their guidance on safe handover the British Medical Association (BMA) advised that "clinically unstable patients are known to the senior and covering clinicians; tasks should be prioritised; plans for further care are put in place; unstable patients are reviewed." The orthopaedic department at King's College Hospital, a busy major trauma centre in London, UK, has a significantly reduced workforce during the weekend. The general consensus was that the ward round was taking too long, giving the foundation year one (FY1) doctor very little time to commit to other ward jobs and reviewing unstable patients, making it a stressful and challenging environment. The electronic patient record (EPR), an electronic programme available on all Trust computers, is already a very reliable way to allow safe handover of information via a central electronic database. However it has limitations in clearly prioritising more unstable patients from those needing routine review. We created an easily identifiable traffic light coding system that could be simply incorporated into the electronic handover that was re-reviewed and finalised in order to improve the ability to prioritise patients for senior review. This in turn would directly impact the efficiency of the ward round and improve patient safety. Our immediate results demonstrated the efficiency of the ward round improved in all parameters: time to complete the ward round improved from 7.1% to 50%; prioritisation and ability to highlight the clinical urgency for patient review improved from 15.4% to 100%; and more notably, the clinician's impression of patient safety improved from 38.5% to 100%. Overall the introduction of an uncomplicated traffic light system provided an effective addition to the electronic handover structure aimed to allow patient prioritisation and improved efficiency during weekend hours.
英国医学总会（GMC）指出：“管理良好、全面且有条理的交接班对于确保患者护理的质量和安全至关重要。” 英国医学协会（BMA）在其关于安全交接班的指南中建议：“高级和值班临床医生应了解临床不稳定患者的情况；应优先安排任务；应制定进一步护理计划；应对不稳定患者进行复查。” 位于英国伦敦的一家繁忙的主要创伤中心——国王学院医院的骨科，在周末期间工作人员大幅减少。普遍的共识是，查房时间过长，使得第一年基础培训（FY1）医生几乎没有时间去做其他病房工作以及复查不稳定患者，营造了一个压力大且具有挑战性的环境。电子病历（EPR）是所有信托计算机上都可用的电子程序，它已经是通过中央电子数据库进行安全信息交接的一种非常可靠的方式。然而，在从需要常规复查的患者中明确区分出更不稳定的患者方面，它存在局限性。我们创建了一个易于识别的交通信号灯编码系统，该系统可以简单地纳入电子交接班中，并经过重新审查和最终确定，以提高为高级复查确定患者优先级的能力。这反过来将直接影响查房效率并提高患者安全。我们的即时结果表明，查房效率在所有参数上都有所提高：完成查房的时间从7.1% 提高到了50%；确定优先级以及突出患者复查临床紧迫性的能力从15.4% 提高到了100%；更值得注意的是，临床医生对患者安全的印象从38.5% 提高到了100%。总体而言，引入一个简单的交通信号灯系统有效地补充了电子交接班结构，旨在实现患者优先级排序并提高周末时段的效率。
