Koli Trupti, Filippidou Maria
Luton And Dunstable Hospital, Bedfordshire, Bedford, UK,
Psychiatr Danub. 2017 Sep;29(Suppl 3):536-540.
The importance of handovers has been recognised and proven in clinical practice. In liaison psychiatry, this is particularly important due to the high turnover of patients seen, the shift work pattern and the number of member staff engaging in this process. An Audit on the Quality of Handovers was carried out within a Psychiatric Liaison team of a General hospital in UK with an intention to review and improve this.
Handovers were evaluated against the gold standard of the SBAR tool (Situation/Background/Assessment/Recommendations) over a period of 4 weeks. Handovers were assessed by 2 members of staff (a Consultant & a Specialty doctor). Data was analysed using Microsoft Excel.
Results showed that the team's handover practice is mostly "Good" but there was also an amount of "Poor" under "Situation & Background", mostly presented by mid-grade doctors & trainees. Nurses scored higher than medics on overall rating, nearly 50%.This could be attributed to the fact that handovers form an essential & integral part of Nurse's training & culture. Also mid-grade (staff grade) doctors have had a significant amount of "excellent" scoring that other groups didn't have, mostly on the Assessment & Recommendations domains, which can be attributed to the fact that importance is stressed more on the assessment & treatment module by the doctors.
The multi-disciplinary composition of the liaison psychiatry team has a positive impact on the patient care. This audit has revealed overall good communication amongst the members of the team, nevertheless one that needs some improvement, particularly amongst the doctors. Doctors tend to focus on the remedial (assessment & treatment) module rather than the holistic approach. SBAR remains an effective & handy tool to improve the handover quality. A re-audit will be carried out in 6 months time to assess the improvements observed following the implementation of this new tool.
交接班的重要性在临床实践中已得到认可和证实。在联络精神病学中,由于就诊患者周转快、轮班工作模式以及参与该过程的工作人员数量众多,这一点尤为重要。英国一家综合医院的精神病联络团队进行了一次交接班质量审计,旨在审查并改进这一情况。
在4周的时间内,对照SBAR工具(情况/背景/评估/建议)的黄金标准对交接班情况进行评估。由两名工作人员(一名顾问医生和一名专科医生)对交接班情况进行评估。使用微软Excel软件对数据进行分析。
结果显示,该团队的交接班实践大多为“良好”,但在“情况与背景”方面也存在一些“较差”的情况,主要由中级医生和实习医生表现出来。护士在总体评分上高于医生,近50%。这可能归因于交接班是护士培训和文化的重要组成部分。此外,中级( staff grade)医生在“优秀”评分方面的比例显著高于其他群体,主要在评估和建议领域,这可归因于医生更强调评估和治疗模块的重要性。
联络精神病学团队的多学科构成对患者护理有积极影响。本次审计显示团队成员之间总体沟通良好,但仍需一些改进,尤其是医生之间。医生往往侧重于补救性(评估与治疗)模块,而非整体方法。SBAR仍然是提高交接班质量的有效且便捷的工具。将在6个月后进行重新审计,以评估实施这一新工具后所观察到的改进情况。