Sather John, Rothenberg Craig, Finn Emily B, Sheth Kevin N, Matouk Charles, Pham Laura, Parwani Vivek, Ulrich Andrew, Venkatesh Arjun K
1 Yale School of Medicine, New Haven, CT.
2 Yale New Haven Hospital, New Haven, CT.
Am J Med Qual. 2019 Jan/Feb;34(1):53-58. doi: 10.1177/1062860618785248. Epub 2018 Jul 10.
Critically ill patients may be exposed to unique safety threats as a result of the complexity of interhospital and intrahospital transitions involving the emergency department (ED). Real-time surveys were administered to clinicians in the ED and neuroscience intensive care unit of a tertiary health care system to assess perceptions of handoff safety and quality in transitions involving critically ill neurologic patients. In all, 115 clinical surveys were conducted among 26 patient transfers. Among all clinician types, 1 in 5 respondents felt the handoff process was inadequate. Risks to patient safety during the transfer process were reported by 1 in 3 of respondents. Perceived risks were reported more frequently by nurses (44%) than physicians/advanced practice providers (28%). Real-time survey methodology appears to be a feasible and valuable, albeit resource intensive, tool to identify safety risks, expose barriers to communication, and reveal challenges not captured by traditional approaches to inform multidisciplinary quality improvement efforts.
由于涉及急诊科（ED）的院际和院内转诊流程复杂，重症患者可能面临独特的安全威胁。对一家三级医疗保健系统的急诊科和神经科学重症监护病房的临床医生进行了实时调查，以评估在涉及重症神经系统疾病患者的转诊过程中对交接安全性和质量的看法。在26例患者转诊中，共进行了115次临床调查。在所有临床医生类型中，五分之一的受访者认为交接过程不充分。三分之一的受访者报告了转诊过程中对患者安全的风险。护士（44%）比医生/高级执业提供者（28%）更频繁地报告感知到的风险。实时调查方法似乎是一种可行且有价值的工具，尽管资源密集，可用于识别安全风险、揭示沟通障碍，并揭示传统方法未捕捉到的挑战，为多学科质量改进工作提供信息。
