Caruso Thomas J, Marquez Juan Luis Sandin, Gipp Melanie S, Kelleher Stephen P, Sharek Paul J
Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital, Stanford, California, USA.
University of Michigan , Ann Arbor, Michigan, USA.
Int J Health Care Qual Assur. 2017 May 8;30(4):304-311. doi: 10.1108/IJHCQA-02-2016-0015.
Purpose No studies have examined preoperative handoffs from the intensive care unit (ICU) to OR. Given the risk of patient harm, the authors developed a standardized ICU to OR handoff using a previously published handoff model. The purpose of this paper is to determine whether a standardized ICU to OR handoff process would increase the number of team handoffs and improve patient transport readiness. Design/methodology/approach The intervention consisted of designing a multidisciplinary, face-to-face handoff between sending ICU providers and receiving anesthesiologist and OR nurse, verbally presented in the I-PASS format. Anticipatory calls from the OR nurse to the ICU nurse were made to prepare the patient for transport. Data collected included frequency of handoff, patient transport readiness, turnover time between OR cases, and anesthesia provider satisfaction. Findings In total, 57 audits were completed. The frequency of handoffs increased from 25 to 86 percent ( p<0.0001) and the frequency of patient readiness increased from 61 to 97 percent ( p=0.001). There were no changes in timeliness of first start cases and no significant change in turnover times between cases. Anesthesia provider satisfaction scores increased significantly. Practical implications A standardized, team based ICU to OR handoff increased the frequency of face-to-face handoffs, patient readiness and anesthesia provider satisfaction within increasing turnover between cases. Originality/value Although studies have identified the transition of patients from the ICU to the OR as a period of increased harm, the development of a preoperative ICU to OR handoff had not been described. This intervention may be used in other institutions to design ICU to OR transitions of care.
目的 尚无研究对从重症监护病房(ICU)到手术室的术前交接进行考察。鉴于患者存在受到伤害的风险,作者采用先前发表的交接模式制定了一种标准化的ICU到手术室交接流程。本文的目的是确定标准化的ICU到手术室交接流程是否会增加团队交接的次数并提高患者转运准备情况。 设计/方法/途径 干预措施包括设计一种多学科的、由ICU交班人员与接收的麻醉医生及手术室护士进行的面对面交接,以I-PASS格式进行口头汇报。手术室护士提前致电ICU护士,为患者转运做准备。收集的数据包括交接频率、患者转运准备情况、手术间周转时间以及麻醉医生满意度。 结果 总共完成了57次审核。交接频率从25%增至86%(p<0.0001),患者准备就绪的频率从61%增至97%(p=0.001)。首例手术开始的及时性未发生变化,手术间周转时间也无显著改变。麻醉医生满意度得分显著提高。 实际意义 标准化的、基于团队的ICU到手术室交接在增加手术间周转次数的情况下,提高了面对面交接的频率、患者准备就绪程度以及麻醉医生满意度。 原创性/价值 尽管已有研究确定患者从ICU转至手术室期间伤害风险增加,但此前尚未描述过术前ICU到手术室交接流程的制定情况。该干预措施可用于其他机构设计ICU到手术室的护理交接。