Pincavage Amber T, Donnelly Michael J, Young John Q, Arora Vineet M
Jt Comm J Qual Patient Saf. 2017 Feb;43(2):71-79. doi: 10.1016/j.jcjq.2016.11.006. Epub 2016 Nov 15.
Year-end clinic handoffs in resident continuity clinics are an important patient safety issue.
Intervention articles addressing the year-end resident clinic handoff were identified in a targeted literature search. These articles were reviewed and abstracted to summarize the current literature. On the basis of these reviews and consensus expert opinion, recommendations to improve year-end clinic handoffs were developed.
Of 23 identified articles, 10 intervention articles in the fields of internal medicine, internal medicine-pediatrics, psychiatry, and family medicine were ultimately included. The additional 13 nonintervention studies were used as background material. There were 12 clinic handoff recommendations for improvement: (1) focus on patients most at risk during the handoff, (2) educate residents, (3) consider balancing caseloads for the residents, (4) prepare patients for the handoff and perform patient-centered outreach, (5) standardize a written method of sign-out and require verbal communication for a subset of patients, (6) use a standardized template or technology solution for the handoff, (7) identify specific tasks that require follow-up, (8) enhance attending supervision during the handoff, (9) make patient assignments clear after the handoff, (10) have patients establish care with the new provider as soon as possible after the handoff, (11) establish care with telephone contact prior to the first visit, (12) perform safety audits to ensure that sign-out occurs, patients receive appointments, no-shows are rescheduled, and task follow-up is completed.
There is emerging evidence for interventions to improve year-end resident clinic handoffs, and the recommendations provided are a starting point to guide training programs.
住院医师连续性诊所的年终临床工作交接是一个重要的患者安全问题。
在有针对性的文献检索中确定了关于年终住院医师诊所工作交接的干预性文章。对这些文章进行了综述和摘要，以总结当前的文献。基于这些综述和专家共识意见，制定了改进年终诊所工作交接的建议。
在23篇已确定的文章中，最终纳入了内科、内科 - 儿科、精神病学和家庭医学领域的10篇干预性文章。另外13篇非干预性研究用作背景材料。有12条改进诊所工作交接的建议：（1）在交接过程中关注风险最高的患者；（2）对住院医师进行教育；（3）考虑平衡住院医师的工作量；（4）让患者为交接做好准备并开展以患者为中心的宣传；（5）规范书面交班方法，并要求对部分患者进行口头沟通；（6）使用标准化模板或技术解决方案进行交接；（7）确定需要跟进的具体任务；（8）在交接过程中加强主治医生的监督；（9）交接后明确患者分配；（10）让患者在交接后尽快与新医生建立诊疗关系；（11）在首次就诊前通过电话联系建立诊疗关系；（12）进行安全审核，以确保完成交班、患者获得预约、失约患者重新安排时间以及任务跟进完成。
有新的证据表明存在可改善年终住院医师诊所工作交接的干预措施，所提供的建议是指导培训项目的一个起点。
