Kobo-Greenhut Ayala, Shnifi Amin, Tal-Or Eran, Magnezi Racheli, Notea Amos, Ruach Meir, Onn Erez, Cohen Ayala, Doveh Etti, Ben Shlomo Izhar
Department of Management, Bar Ilan University, Ramat Gan, Israel.
Department of Quality Engineering, Kinneret College, Eder 42, Haifa, Israel.
Int J Qual Health Care. 2017 Apr 1;29(2):206-212. doi: 10.1093/intqhc/mzw156.
To compare the effectiveness of two methods in encouraging the consideration of a leap from one patient management routine to another: (i) real-time review of the facts by an external medical team (ii) implementation of the 're-thinking-protocol' ('de-Freezing') by both treating and external medical teams.
Students accompanied doctors, nurses and patients as non-interrupting observers. When an obvious gap between the expected and actual findings occurred, it was discussed four times: by two teams (treating team, external medical team) in two discussion modes (real-time review, de-Freezing-questionnaire). The students then recorded if a leap was considered for each discussion.
The study was conducted in the emergency department of the Baruch Padeh Medical Centre, Poriya, Israel.
All patients were included during times when both medical teams (treating, external) were present.
INTERVENTION(S): During 14 periods of 5-7 h each, 459 patients were sampled. In 183 patients, 200 gaps were discovered.
The external team considered a leap 76 times, compared with 47 by the treating team (P < 0.001). Using the de-Freezing-protocol, the treating team considered a leap 133 times. Interestingly, even the external team benefited from the de-Freezing protocol and considered a leap 140 times (NS compared to the treating team).
While the importance of timely leaping from one patient management routine to another is emphasized in the training of physicians, medical teams too often fail to do so. The de-Freezing-protocol inexpensively encourages the consideration of a leap beyond what is evoked by the involvement of an external team. The protocol is applicable to all medical processes and should be incorporated into medical practice and education.
比较两种方法在促使从一种患者管理常规转向另一种常规方面的有效性：（i）由外部医疗团队实时审查事实；（ii）治疗团队和外部医疗团队实施“重新思考协议”（“解冻”）。
学生作为不打断的观察者陪同医生、护士和患者。当预期结果与实际结果出现明显差距时，进行四次讨论：由两个团队（治疗团队、外部医疗团队）以两种讨论模式（实时审查、解冻问卷）进行。然后学生记录每次讨论中是否考虑了转变。
该研究在以色列波里亚的巴鲁克·帕德赫医疗中心急诊科进行。
在两个医疗团队（治疗团队、外部团队）都在场的时间段纳入所有患者。
在14个时长为5 - 7小时的时间段内，对459名患者进行抽样。在183名患者中发现了200个差距。
外部团队考虑转变76次，而治疗团队为47次（P < 0.001）。使用解冻协议，治疗团队考虑转变133次。有趣的是，即使是外部团队也从解冻协议中受益，考虑转变140次（与治疗团队相比无显著差异）。
虽然在医生培训中强调了及时从一种患者管理常规转向另一种常规的重要性，但医疗团队往往做不到这一点。解冻协议以低成本促使人们考虑超越外部团队参与所引发的转变。该协议适用于所有医疗过程，应纳入医疗实践和教育中。
