Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Froedtert Health, Milwaukee, Wisconsin, USA.
BMJ Qual Saf. 2017 Dec;26(12):987-992. doi: 10.1136/bmjqs-2017-006657. Epub 2017 Aug 7.
Poor sign-out or handover of care may lead to preventable patient harm. Critically ill patients in intensive care units (ICU) are complex and prone to rapid clinical deterioration. If clinical deterioration occurs, timeliness of appropriate interventions is essential to prevent or reduce adverse outcomes. Therefore sign-outs need to efficiently transmit key information and provide anticipatory guidance. Interventions to improve resident-to-resident ICU sign-outs have not been well described. We conducted a controlled trial to test the effectiveness of a standardised ICU sign-out process to the usual ICU sign-out.
Prospective controlled trial.
A 26-bed medical intensive care unit (MICU) in an urban tertiary academic medical centre.
Residents rotating through the MICU.
ICU-specific written sign-out template.
Residents completed postcall surveys assessing satisfaction with verbal and written sign-outs and incidence of non-routine events. Our main outcome of interest was the occurrence of non-routine events.
Compared with the intervention group, on significantly more nights, night float residents in the control group encountered patients who were sicker than sign-out would have suggested (15.94% vs 43.75%; p<0.0001). On significantly fewer nights, night float residents in the intervention group indicated that either something happened to patients that was unexpected (18.84% vs 36.51%; p=0.023) or they were insufficiently prepared for (4.35% vs 35.94%; p<0.0001). Similarly, on fewer nights, residents in the intervention group indicated that they had to perform interventions that were unplanned or unanticipated (15.9% vs 37.7%; p=0.005).
A structured sign-out process compared with usual sign-out significantly reduced the occurrence of non-routine events in an academic MICU.
护理交班或交接不善可能导致可预防的患者伤害。重症监护病房（ICU）中的危重症患者情况复杂，容易迅速恶化。如果出现临床恶化，及时进行适当的干预对于预防或减少不良后果至关重要。因此，交班需要有效地传递关键信息并提供预期指导。改善住院医师之间 ICU 交班的干预措施尚未得到很好的描述。我们进行了一项对照试验，以测试标准化 ICU 交班流程对常规 ICU 交班的有效性。
前瞻性对照试验。
城市三级学术医疗中心的 26 张病床的内科重症监护病房（MICU）。
轮转至 MICU 的住院医师。
特定于 ICU 的书面交班模板。
住院医师完成了呼叫后调查，评估了口头和书面交班的满意度以及非常规事件的发生率。我们感兴趣的主要结果是发生非常规事件的情况。
与对照组相比，干预组夜间遇到的患者病情比交班时预计的要严重的情况明显更多（15.94%比 43.75%；p<0.0001）。在干预组中，夜间值班住院医师表示，夜间值班时发生了意想不到的情况（18.84%比 36.51%；p=0.023）或准备不足的情况明显更少（4.35%比 35.94%；p<0.0001）。同样，在干预组中，夜间值班住院医师表示，他们不得不进行计划外或未预期的干预措施的情况明显更少（15.9%比 37.7%；p=0.005）。
与常规交班相比，结构化交班流程显著减少了学术性 MICU 中非计划性事件的发生。
