Seligman Eva, Malakooti Marcelo
Pediatric Emergency Medicine, Johns Hopkins Children's Center.
Division of Critical Care, Ann & Robert H Lurie Children's Hospital of Chicago/northwestern University Feinberg School of Medicine.
Cureus. 2018 Apr 30;10(4):e2558. doi: 10.7759/cureus.2558.
Introduction At our institution, inpatient pediatric residents spend about 50 hours each month on 52 total handoff encounters. We created a modifiable electronic handoff tool (LURIES) and measured its impact on resident perception of self-efficacy. We also elicited feedback and identified topics omitted in the handoffs following its adoption on general medicine, intensive care, and sub-specialty wards. Our objective was to standardize the handoff tool used by residents and to measure the impact of the new tool on resident perception of self-efficacy. Methods Residents were trained to use LURIES and completed a voluntary online survey during the first and second year of implementation. Senior residents reflected on experiences prior to and after implementation of LURIES. Night team residents reported key items omitted from the handoff. Results 65/96 (68%) residents responded in year one and 45/97 (46%) in year two of implementation. The majority of residents perceived that LURIES improved handoff efficiency, promoted active listening, and reduced the number of missed tasks overnight. There was a statistically significant increase in self-efficacy for all queried overnight tasks. Omitted information was most commonly identified on complex subspecialty services and pertained to communication with parents, late admissions, and discharges. Conclusion LURIES increased resident self-efficacy with patient management. There was no difference in findings when controlled for previous medical school handoff training or type of handoff tool used in medical school clerkships. More data are needed to establish the significance of this trend in relation to handoffs beyond residency, patient safety, and patient satisfaction scores.
引言 在我们机构，住院儿科住院医师每月在总共52次交接班中花费约50小时。我们创建了一个可修改的电子交接班工具（LURIES），并评估了其对住院医师自我效能感认知的影响。我们还收集了反馈意见，并确定了该工具在普通内科、重症监护和亚专科病房采用后交接班中遗漏的主题。我们的目标是规范住院医师使用的交接班工具，并评估新工具对住院医师自我效能感认知的影响。方法 住院医师接受了使用LURIES的培训，并在实施的第一年和第二年完成了一项自愿在线调查。高级住院医师反思了LURIES实施前后的经历。夜班团队住院医师报告了交接班中遗漏的关键项目。结果 在实施的第一年，65/96（68%）名住院医师做出了回应，第二年为45/97（46%）。大多数住院医师认为LURIES提高了交接班效率，促进了积极倾听，并减少了夜间遗漏任务的数量。所有查询的夜间任务的自我效能感都有统计学上的显著提高。遗漏信息最常出现在复杂的亚专科服务中，涉及与家长的沟通、延迟入院和出院。结论 LURIES提高了住院医师在患者管理方面的自我效能感。在控制了之前医学院的交接班培训或医学院实习中使用的交接班工具类型后，结果没有差异。需要更多数据来确定这一趋势在住院医师培训之外的交接班、患者安全和患者满意度评分方面的意义。
