Lo Huay-Ying, Mullan Paul C, Lye Cara, Gordon Mary, Patel Binita, Vachani Joyee
United States.
BMJ Qual Improv Rep. 2016 Dec 15;5(1). doi: 10.1136/bmjquality.u212920.w5661. eCollection 2016.
Handoffs represent a critical transition point in patient care that play a key role in patient safety. Our quality improvement project was a descriptive observational study aimed at standardizing pediatric hospitalist handoffs via implementation of a handoff checklist, with the goal of improving handoff quality and physician satisfaction within six months. The handoff checklist was quickly adapted by hospitalists, with median compliance rate of 83% during the study. Handoff quality was assessed by trained observers using the validated Handoff Clinical Evaluation Exercise (CEX) tool at multiple time periods pre- and post-implementation (at 2, 6, 12, and 24 months). Handoff quality improved during our study, with a significant decrease in the percentage of "unsatisfactory" handoffs from 9% to 0% (p-value 0.004), an effect which was sustained after initial project completion. The cumulative time required for verbal handoffs for different attending physicians paralleled patient census. However, our project identified wasted down time between individual physician handoffs, and an intervention to change shift times led to a decrease in the average total handoff process time from 86 minutes to 60 minutes, p-value <0.001. An average of 7.4 patient care items was identified during handoffs. A physician perception survey revealed improved situational awareness, efficiency, patient safety, and physician satisfaction as a result of our handoff improvement project. In conclusion, implementation of a checklist and standardized handoff process for pediatric hospitalists improved handoff efficiency and quality, as well as physician satisfaction.
交接班是患者护理过程中的一个关键过渡点，对患者安全起着关键作用。我们的质量改进项目是一项描述性观察性研究，旨在通过实施交接班检查表来规范儿科住院医师的交接班流程，目标是在六个月内提高交接班质量和医生满意度。住院医师很快就采用了交接班检查表，在研究期间的中位依从率为83%。在实施前和实施后的多个时间段（2个月、6个月、12个月和24个月），由经过培训的观察员使用经过验证的交接班临床评估练习（CEX）工具对交接班质量进行评估。在我们的研究期间，交接班质量有所提高，“不满意”交接班的百分比从9%显著下降到0%（p值为0.004），这一效果在项目初步完成后仍持续存在。不同主治医生进行口头交接班所需的累计时间与患者普查情况相似。然而，我们的项目发现了个别医生交接班之间存在的时间浪费，一项改变轮班时间的干预措施使平均总交接班流程时间从86分钟减少到60分钟，p值<0.001。在交接班过程中平均发现7.4项患者护理事项。一项医生认知调查显示，由于我们的交接班改进项目，情境意识、效率、患者安全和医生满意度都有所提高。总之，为儿科住院医师实施检查表和标准化的交接班流程提高了交接班效率和质量，以及医生满意度。
