Department of Surgery, University of Washington Medical Center, Seattle.
Department of General Internal Medicine, University of Washington Medical Center, Seattle.
JAMA Surg. 2018 May 1;153(5):464-470. doi: 10.1001/jamasurg.2017.5440.
Clinician miscommunication contributes to an estimated 250 000 deaths in US hospitals per year. Efforts to standardize handoff communication may reduce errors and improve patient safety.
To determine the effect of a standardized handoff curriculum, UW-IPASS, on interclinician communication and patient outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized stepped-wedge randomized clinical trial was conducted from October 2015 to May 2016 at 8 medical and surgical intensive care units at 2 hospital systems within an academic tertiary referral center. Participants included residents, fellows, advance-practice clinicians, and attending physicians (n = 106 clinicians, with 1488 handoff events over 8 months) and data were collected from daily text message-based surveys and patient medical records.
The UW-IPASS standardized handoff curriculum.
The primary aim was to assess the effect of the UW-IPASS handoff curriculum on perceived adequacy of interclinician communication. Patient days of mechanical ventilation, intensive care unit length of stay, reintubations within 24 hours, and order workflow patterns were also analyzed. Mixed-effects logistic regression was used to compute odds ratios and confidence intervals with adjustment for location, time period, and clinician.
A total of 63 residents and advance practice clinicians, 13 fellows, and 30 attending physicians participated in the study. During the control period, clinicians reported being unprepared for their shift because of a poor-quality handoff in 35 of 343 handoffs (10.2%), while UW-IPASS-period residents reported being unprepared in 53 of 740 handoffs (7.2%) (odds ratio, 0.19; 95% CI, 0.03-0.74; P = .03). Compared with the control phase, the perceived duration of handoffs among clinicians using UW-IPASS was unchanged (+5.5 minutes; 95% CI, 0.34-9.39; P = .30). Early morning order entry decreased from 106 per 100 patient-days in the control phase to 78 per 100 patient-days in the intervention period (-28 orders; 95% CI, -55 to -4; P = .04). Overall, UW-IPASS was not associated with any changes in intensive care unit length of stay, duration of mechanical ventilation, or the number of reintubations.
The UW-IPASS standardized handoff curriculum was perceived to improve intensive care provider preparedness and workflow. IPASS-based curricula represent an important step forward in communication standardization efforts and may help reduce communication errors and omissions.
isrctn.org Identifier: ISRCTN14209509.
临床医生沟通不当导致美国医院每年约有 25 万人死亡。努力使交接班沟通标准化可能会减少错误并提高患者安全性。
确定标准化交接班课程 UW-IPASS 对临床医生之间的沟通和患者结局的影响。
设计、设置和参与者：这是一项在学术三级转诊中心的 2 个医院系统的 8 个医疗和外科重症监护病房进行的集群随机分步楔形随机临床试验。参与者包括住院医师、研究员、高级实践临床医生和主治医生（n=106 名临床医生，在 8 个月内进行了 1488 次交接班），并通过日常基于短信的调查和患者病历收集数据。
UW-IPASS 标准化交接班课程。
主要目的是评估 UW-IPASS 交接班课程对临床医生之间沟通的感知充分性的影响。还分析了患者机械通气天数、重症监护病房住院时间、24 小时内重新插管以及医嘱流程模式。使用混合效应逻辑回归计算了优势比和置信区间，并进行了位置、时间段和临床医生的调整。
共有 63 名住院医师和高级实践临床医生、13 名研究员和 30 名主治医生参加了这项研究。在对照期，343 次交接班中有 35 次（10.2%）临床医生因交接班质量差而报告称他们对轮班准备不足，而 UW-IPASS 期住院医师报告称在 740 次交接班中有 53 次（7.2%）（优势比，0.19；95%CI，0.03-0.74；P=0.03）对轮班准备不足。与对照阶段相比，使用 UW-IPASS 的临床医生对交接班时间的感知没有变化（+5.5 分钟；95%CI，0.34-9.39；P=0.30）。早期医嘱输入从对照期的每 100 个患者日 106 次减少到干预期的每 100 个患者日 78 次（-28 次；95%CI，-55 至-4；P=0.04）。总体而言，UW-IPASS 与重症监护病房住院时间、机械通气时间或重新插管次数均无变化相关。
UW-IPASS 标准化交接班课程被认为可以提高重症监护提供者的准备情况和工作流程。基于 IPASS 的课程是沟通标准化努力的重要一步，可能有助于减少沟通错误和遗漏。
isrctn.org 标识符：ISRCTN14209509。
