Walia Jasmine, Qayumi Zainab, Khawar Nayaab, Dygulska Beata, Bialik Ilya, Salafia Carolyn, Narula Pramod
New York Methodist Hospital, Brooklyn, NY.
New York Methodist Hospital, Brooklyn, NY.
Acad Pediatr. 2016 Aug;16(6):519-23. doi: 10.1016/j.acap.2016.04.001. Epub 2016 Apr 16.
Miscommunication is a leading cause of adverse events in hospitals. Optimizing the handoff process improves communication and patient safety. We sought to assess how the components of I-PASS (a mnemonic for illness severity, patient summary, action list, situational awareness with contingency planning, and synthesis by the receiver), a standardized handoff bundle, improved the quality of handoffs in a pediatric residency program based in a community hospital.
Pediatric residents in a university-affiliated community teaching hospital were observed on the pediatric inpatient floor and in the newborn nursery. One hundred resident handoffs per setting were analyzed in 3 phases, with a total of 600 handoffs assessed. Phase 1 comprised preintervention handoffs before I-PASS; phase 2, initiating I-PASS mnemonic and educational session; and phase 3, implementing a handoff tool, electronic physician handoff (EPH), into the electronic medical record. One attending physician at each setting assessed the handoff process using an 11-item survey. A resident satisfaction survey assessed the resident's experience after phase 3.
Comparing phase 1 with phase 2, there was improved situational awareness with contingency planning (nursery: 12% to 83%, P = .001; floor: 21% to 84%, P = .001). Incidence of tangential conversation decreased in both settings (nursery: 100% to 23%, P = .001; floor: 84% to 11%, P = .001). Comparing phase 2 with phase 3, there was improvement in identification of illness severity (nursery: 62% to 99%, P = .001; floor: 41% to 64%, P = .001) and fewer omissions of important information (nursery: 14% to 0%, P = .001; floor: 33% to 17%, P = .007). A total of 93% of residents found the new EPH system to be beneficial.
Specific components of a standardized handoff system, including a mnemonic, an educational intervention, and an EPH, improved the clarity and organization of key information in handoff.
沟通不畅是医院不良事件的主要原因。优化交接班流程可改善沟通并提高患者安全。我们旨在评估标准化交接班套餐I-PASS（病情严重程度、患者总结、行动清单、具有应急计划的态势感知以及接收者综合情况的助记符）的各个组成部分如何改善社区医院儿科住院医师培训项目中的交接班质量。
在大学附属社区教学医院的儿科住院部和新生儿重症监护室观察儿科住院医师。在三个阶段对每个环境中的100次住院医师交接班进行分析，共评估600次交接班。第一阶段包括I-PASS之前的干预前交接班；第二阶段，启动I-PASS助记符和教育课程；第三阶段，在电子病历中实施交接班工具电子医师交接班（EPH）。每个环境中的一名主治医师使用11项调查问卷评估交接班过程。一项住院医师满意度调查评估了第三阶段后住院医师的体验。
将第一阶段与第二阶段进行比较，具有应急计划的态势感知得到改善（重症监护室：从12%提高到83%，P = 0.001；住院部：从21%提高到84%，P = 0.001）。两个环境中离题谈话的发生率均下降（重症监护室：从100%降至23%，P = 0.001；住院部：从84%降至11%；P = 0.001）。将第二阶段与第三阶段进行比较，病情严重程度的识别得到改善（重症监护室：从62%提高到99%，P = 0.001；住院部：从41%提高到64%，P = 0.001），重要信息的遗漏减少（重症监护室：从14%降至0%，P = 0.001；住院部：从33%降至17%，P = 0.007）。共有93%的住院医师认为新的EPH系统有益。
标准化交接班系统的特定组成部分，包括助记符、教育干预和EPH，提高了交接班关键信息的清晰度和条理性。
