From the Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Denmark.
J Patient Saf. 2020 Sep;16(3):199-210. doi: 10.1097/PTS.0000000000000266.
Despite of the increasing knowledge about patient safety improvements in the handover process in hospitals, we still lack knowledge about what magnitude of patient safety gains can be expected from improvements in handover between the intensive care unit (ICU) and the general ward. The aim of this systematic review was to investigate which handover tools are devised and evaluated with the aim of improving patient safety in the handover process from ICU to ward and whether the described handover tools fulfill their purpose.
A systematic literature search of 6 databases was performed to answer the review question, developed by using the "Patient Population, Intervention, Comparison, Outcome" format. Two authors independently performed the selection process, as well as the data extraction and quality assessment. The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement were followed.
Eight studies were finally included in the qualitative analysis. One study investigated a written information tool, 1 study investigated improved verbal information, 1 study investigated the effect of an additional safety check, and 5 studies investigated a Liaison Nurse as handover tool. Because of heterogeneity among the included studies, the study results could not be pooled.
Not many well-conducted studies can shed light on this important topic. Giving patients and their families a supplementary written or verbal status report before transfer might improve patient safety. The introduction of a Liaison Nurse may be effective in improving communication between ICU and ward staff, which might reduce risks in patient safety. However, there is no evidence of improved mortality and/or readmission rates after introducing handover tools in the transfer from ICU to ward.
尽管人们越来越了解医院交接过程中患者安全的改进，但我们仍然缺乏关于从重症监护病房（ICU）到普通病房交接过程中改进可预期能带来多大程度的患者安全收益的知识。本系统评价的目的是调查旨在提高 ICU 到病房交接过程中患者安全的交接工具的设计和评估情况，以及这些描述的交接工具是否达到其目的。
使用“患者人群、干预、比较、结局”格式，对 6 个数据库进行了系统文献检索，以回答综述问题。两位作者独立进行了选择过程、数据提取和质量评估。遵循系统评价和荟萃分析报告的首选报告项目的建议。
最终有 8 项研究被纳入定性分析。1 项研究调查了书面信息工具，1 项研究调查了改进的口头信息，1 项研究调查了附加安全检查的效果，5 项研究调查了联络护士作为交接工具。由于纳入研究之间存在异质性，因此无法对研究结果进行汇总。
很少有精心设计的研究能够阐明这个重要的问题。在转移前向患者及其家属提供补充的书面或口头状态报告可能会提高患者安全性。引入联络护士可能会有效改善 ICU 和病房工作人员之间的沟通，从而降低患者安全风险。然而，在从 ICU 到病房的交接中引入交接工具后，并没有证据表明死亡率和/或再入院率有所改善。
