Wilk S, Siegl L, Siegl K, Hohenstein C
Klinik X für Anästhesiologie, Intensivmedizin, Schmerztherapie und Notfallmedizin, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland.
Zentrum für Notfallmedizin, Universitätsklinikum Jena, Jena, Deutschland.
Anaesthesist. 2018 Apr;67(4):255-263. doi: 10.1007/s00101-018-0413-x. Epub 2018 Feb 5.
In an analysis of a critical incident reporting system (CIRS) in out-of-hospital emergency medicine, it was demonstrated that in 30% of cases deficient communication led to a threat to patients; however, the analysis did not show what exactly the most dangerous work processes are. Current research shows the impact of poor communication on patient safety.
An out-of-hospital workflow analysis collects data about key work processes and risk areas. The analysis points out confounding factors for a sufficient communication. Almost 70% of critical incidents are based on human factors. Factors, such as communication and teamwork have an impact but fatigue, noise levels and illness also have a major influence.
(I) CIRS database analysis The workflow analysis was based on 247 CIRS cases. This was completed by participant observation and interviews with emergency doctors and paramedics. The 247 CIRS cases displayed 282 communication incidents, which are categorized into 6 subcategories of miscommunication. One CIRS case can be classified into different categories if more communication incidents were validated by the reviewers and four experienced emergency physicians sorted these cases into six subcategories. (II) Workflow analysis The workflow analysis was carried out between 2015 and 2016 in Jena and Berlin, Germany. The focal point of research was to find accumulation of communication risks in different parts of prehospital patient care. During 30 h driving with emergency ambulances, the author interviewed 12 members of the emergency medical service of which 5 were emergency physicians and 7 paramedics. A total of 11 internal medicine cases and one automobile accident were monitored. After patient care the author asked in a 15-min interview if miscommunication or communication incidents occurred.
(I) CIRS analysis Between 2005 and 2015, 845 reports were reported to the database. The experts identified 247 incident reports with communication failure. All communication aspects were analyzed and classified. We identified 282 communication incidents. (II) Workflow analysis The analysis showed three phases of prehospital patient care: 1. incoming emergency call and dispatch of ambulance service, 2. prehospital treatment, 3. transportation to a hospital. Overall, the number of incidences is increasing as a consequence of parallel workflows. Category 1 was particularly significant and predominantly, paramedics criticized that emergency physicians did not acknowledge their advice (n = 73 vs. n = 9). Category 3 with n = 63, category 4 with n = 20 and category 2 with n = 13 were the major reasons for incidents.
A better interface communication helps to coordinate patient transfer and is an option for optimizing resources. Frequent training in communication is an option to avoid incidents.
在一项对院外急诊医学中的危急事件报告系统（CIRS）的分析中，结果表明，在30%的案例中，沟通不足对患者构成了威胁；然而，该分析并未表明最危险的工作流程究竟是什么。当前的研究显示了沟通不畅对患者安全的影响。
一项院外工作流程分析收集了有关关键工作流程和风险领域的数据。该分析指出了实现充分沟通的混杂因素。几乎70%的危急事件是基于人为因素。沟通和团队合作等因素有影响，但疲劳、噪音水平和疾病也有重大影响。
（I）CIRS数据库分析 工作流程分析基于247例CIRS案例。通过参与观察以及对急诊医生和护理人员的访谈来完成此项分析。这247例CIRS案例显示了282起沟通事件，这些事件被归类为6种沟通失误的子类别。如果评审人员验证了更多的沟通事件，一个CIRS案例可以被归类到不同类别，并且四位经验丰富的急诊医生将这些案例归类为六个子类别。（II）工作流程分析 工作流程分析于2015年至2016年在德国耶拿和柏林进行。研究的重点是找出院前患者护理不同环节中沟通风险的累积情况。在乘坐急救救护车行驶30小时的过程中，作者采访了12名急救医疗服务人员，其中5名是急诊医生，7名是护理人员。总共监测了11例内科病例和1起汽车事故。在患者护理结束后，作者在15分钟的访谈中询问是否发生了沟通失误或沟通事件。
（I）CIRS分析 在2005年至2015年期间，有845份报告被录入数据库。专家们识别出247份存在沟通失败的事件报告。对所有沟通方面进行了分析和分类。我们识别出282起沟通事件。（II）工作流程分析 分析显示院前患者护理有三个阶段：1. 接到急救电话并派遣救护车服务，2. 院前治疗，3. 送往医院。总体而言，由于并行工作流程，事件数量在增加。第1类尤为显著，主要是护理人员批评急诊医生不认可他们的建议（73例对9例）。第3类有63例，第4类有20例，第2类有13例是事件的主要原因。
更好的界面沟通有助于协调患者转运，是优化资源的一种选择。频繁进行沟通培训是避免事件发生的一种选择。
