Ferguson Alice, Aaronson Barry, Anuradhika Anuradhika
Virginia Mason Medical Center, USA.
BMJ Qual Improv Rep. 2016 Dec 13;5(1). doi: 10.1136/bmjquality.u215856.w7316. eCollection 2016.
Communication is one of the foundations on which safe, high quality care is built. The nature of hospital medicine requires that nurses and providers be efficient and effective in communicating with multiple disciplines. This need for timely communication must continually be balanced with the need to minimize interruptions in workflow. Interruptions not only lead to distraction, they also add inefficiency to the care process and have been shown to contribute to an increased risk of medical error. A major source of interruptions are pagers that emit an audible tone with each message received. This interruptive nature makes pagers a less-than-ideal tool for communicating non-urgent (address within one hour) messages received. In addition to increasing interruptions, pagers do not facilitate closed loop communication, another feature that has been shown to improve safety. Inbox Messaging is intended to provide a less disruptive closed-loop method of communication for non-urgent messages. Inbox Messaging is an interface within the electronic health record (EHR) that functions similarly to e-mail. A multi-disciplinary communication workgroup identified this interface as having potential to not only decrease interruptions, but to also facilitate closed-loop communication. Inbox is currently utilized between the hours of 0700 and 1800 for non-urgent nurse-provider communication about patients on the hospital medicine service. The number of RN non-urgent pages per day was 103 (SD=19, n=97) prior to the Inbox intervention, with a significant decrease (p<.001) during follow-up to 38 (SD=14, n=354) pages per day. At the same time, the number of messages per day increased from 0 to 80 (SD=20, n=354) messages during follow-up. As desired, the mean number of RN urgent pages was unchanged from 13 per day to 13 per day (p=.52). Cerner Inbox Messaging decreases the frequency of non-urgent pager-related interruptions in workflow.
沟通是构建安全、高质量医疗服务的基础之一。医院医疗的性质要求护士和医护人员能够高效且有效地与多个学科进行沟通。这种及时沟通的需求必须不断地与尽量减少工作流程中断的需求相平衡。中断不仅会导致注意力分散，还会增加护理过程的低效性，并且已被证明会增加医疗差错的风险。中断的一个主要来源是寻呼机，每次收到信息时都会发出可听音调。这种干扰性使得寻呼机对于传达收到的非紧急（一小时内处理）信息而言并非理想工具。除了增加中断之外，寻呼机也不利于闭环沟通，而闭环沟通已被证明是另一个能提高安全性的特性。收件箱消息旨在为非紧急消息提供一种干扰性较小的闭环沟通方式。收件箱消息是电子健康记录（EHR）中的一个界面，其功能类似于电子邮件。一个多学科沟通工作组认定这个界面不仅有潜力减少中断，还能促进闭环沟通。目前，收件箱在07:00至18:00之间用于医院内科服务中护士与医护人员就患者进行的非紧急沟通。在收件箱干预之前，注册护士每天的非紧急寻呼次数为103次（标准差=19，n=97），随访期间显著减少（p<0.001）至每天38次（标准差=14，n=354）。与此同时，随访期间每天的消息数量从0增加到80条（标准差=20，n=354）。正如预期的那样，注册护士的紧急寻呼平均次数从每天13次保持不变至每天13次（p=0.52）。Cerner收件箱消息减少了工作流程中与非紧急寻呼机相关的中断频率。
