Bauer Natasha Johan
Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK.
Adv Med Educ Pract. 2016 May 27;7:309-10. doi: 10.2147/AMEP.S107189. eCollection 2016.
Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of England and the British Medical Association.
A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month.
Just over half (52%) of the time, no handover took place. The majority of handovers (64%) occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient's age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care.
These findings were presented to the department, and a handover proforma was implemented. Recommendations included the need for a new face-to-face handover. A reaudit will evaluate the effects of these changes.
新的研究表明，周六和周日入院的患者死亡相对风险分别增加了10%和15%。随着国民医疗服务体系即将面临7天服务的压力，包括周末手术安排，交接在确保患者安全至上方面起着关键作用。本次审核对照英国皇家外科医师学院和英国医学协会发布的安全交接指南，评估了一家三级中心心胸外科手术患者术前和术后交接的质量、效率和安全性。
一份包含16个项目的问卷对交接的性质、时间和时长、患者详细信息、手术史和当前临床状况、交接过程中的干扰以及一个月内跨科室交接的困难进行了前瞻性审核。
超过一半（52%）的时间没有进行交接。大多数交接（64%）通过电话进行；其中三分之二没有被打断。所有交接时长均少于10分钟。约一半的时间里，住院医师之前见过参与交接的住院总医师，但绝大多数人认为如果他们之前有过接触，会有助于交接过程。100%交接的患者详细信息包括姓名、病房和当前临床诊断。三分之一的时间里，患者的年龄、责任顾问医生以及近期的手术或操作没有交接，这可能会因延误和缺乏相关信息而影响未来的治疗。也许最能说明问题的结果是，交接的总体安全性被认为是十分制中的五分，十分表示非常安全，没有任何方面被认为会对最佳患者护理产生负面影响。
这些结果已提交给科室，并实施了一份交接表格。建议包括需要进行新的面对面交接。重新审核将评估这些变化的效果。
