Merkel M J, von Dossow V, Zwißler B
Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität München, München, Deutschland.
Anaesthesist. 2017 Jun;66(6):396-403. doi: 10.1007/s00101-017-0320-6.
Clear and consistent communication is pivotal for well-functioning teamwork, in operating theatres as well as intensive care units. However, patient handovers significantly vary between specialties and locations. If communication is not well structured, it might increase the risk for mishaps and malpractice. Therefore, implementing structured handover protocols is pivotal. The perioperative setting is a high-risk environment that is prone to communication failures due to operational design (frequent change of shift due to working time restrictions) and a high work load and multitasking (operating room management, short surgery times, concurrent emergencies). Hence teamwork in the operating room and intensive care unit requires clear and consistent communication. In the perioperative setting, the patient is transferred several times: from the ward to operating room, to recovery, intermediate care/intensive care unit and back to normal ward. This necessitates multiple handovers. Since 2005, the World Health Organization (WHO) requests a structured handover concept that processes all relevant information in a predefined order. The SBAR concept (situation, background, assessment, recommendation) is an intuitive communication concept that can improve quality of patient handovers. This underlines the clinical relevance of a structured handover concept that leads to improved outcomes for every patient.In this review, basic measures for a clear and consistent communication are presented. These are pivotal for an effective teamwork and for ensuing patient safety. Furthermore, we will focus on possibilities to implement structured approaches but also on potential barriers of implementation. Communication failure among different health care providers can be identified more easily and hopefully can be eliminated.
清晰且一致的沟通对于手术室和重症监护病房中高效运作的团队合作至关重要。然而，患者交接在不同专科和地点之间存在显著差异。如果沟通结构不完善，可能会增加发生事故和医疗失误的风险。因此，实施结构化交接协议至关重要。围手术期环境是一个高风险环境，由于运营设计（因工作时间限制导致班次频繁更换）以及高工作量和多任务处理（手术室管理、手术时间短、并发紧急情况），容易出现沟通失误。因此，手术室和重症监护病房的团队合作需要清晰且一致的沟通。在围手术期，患者会被多次转移：从病房到手术室，再到恢复室、中间护理/重症监护病房，最后回到普通病房。这就需要进行多次交接。自2005年以来，世界卫生组织（WHO）要求采用一种结构化交接概念，按照预定义的顺序处理所有相关信息。SBAR概念（情况、背景、评估、建议）是一种直观的沟通概念，可以提高患者交接的质量。这凸显了结构化交接概念的临床相关性，它能为每个患者带来更好的治疗结果。在本综述中，介绍了实现清晰且一致沟通的基本措施。这些对于有效的团队合作和确保患者安全至关重要。此外，我们将关注实施结构化方法的可能性以及实施过程中的潜在障碍。不同医疗服务提供者之间的沟通失误能够更容易被识别，有望得以消除。
