Hansen Jesse E, Lazow Margot, Hagedorn Philip A
Pediatric Residency Program, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Department of Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Pediatr Qual Saf. 2018 Feb 6;3(1):e053. doi: 10.1097/pq9.0000000000000053. eCollection 2018 Jan-Feb.
Interdisciplinary communication failures contribute to medical mistakes and adverse events. At our institution, provider communication previously occurred through unidirectional pager systems. We utilized quality improvement methodology to (1) implement a secure text messaging system for providers on a pediatric ward and (2) evaluate its impact on communication failures. We aimed to reduce potential communication failures between providers by > 25% within 1 month.
Implementation of secure text messaging occurred via Plan-Do-Study-Act cycles focused on education, feedback, and electronic health record interventions. We collected pager data before implementation and both pager and secure text messaging data after intervention. Potential communication failures were identified a priori through manual review of the messaging data to capture lack of closed-loop communication. A run chart was used to track daily potential communication failures and total communication volumes.
Before implementation of secure text messaging, the median daily potential communication failure rate was 5.5%. Usage of secure text messaging increased after implementation, representing 3.5 of 7.2 communications per patient-day. Paging communications decreased from 4.2 to 3.7 per patient-day. Potential communication failures decreased to a median daily rate of 2.2%, representing a 59% reduction in communication failures.
Implementation of secure text messaging using quality improvement methods resulted in a significant reduction in potential communication failures between residents and nurses. Future interventions will be aimed at maintaining and augmenting providers' use of secure text messaging to ensure the potential for communication failure remains low.
跨学科沟通失误会导致医疗差错和不良事件。在我们机构，此前医护人员通过单向传呼系统进行沟通。我们运用质量改进方法（1）为儿科病房的医护人员实施了一个安全短信系统，以及（2）评估其对沟通失误的影响。我们的目标是在1个月内将医护人员之间潜在的沟通失误减少25%以上。
通过聚焦于教育、反馈和电子健康记录干预的计划-实施-研究-改进循环来实施安全短信系统。我们在实施前收集传呼数据，在干预后收集传呼和安全短信数据。通过人工审核短信数据以捕捉缺乏闭环沟通的情况，从而预先确定潜在的沟通失误。使用运行图来跟踪每日潜在的沟通失误和总通信量。
在实施安全短信系统之前，每日潜在沟通失误率的中位数为5.5%。实施后安全短信的使用量增加，占每位患者每天7.2次沟通中的3.5次。传呼沟通从每位患者每天4.2次降至3.7次。潜在沟通失误降至每日中位数2.2%，表明沟通失误减少了59%。
运用质量改进方法实施安全短信系统显著减少了住院医师与护士之间潜在的沟通失误。未来的干预措施将旨在维持并增加医护人员对安全短信的使用，以确保沟通失误的可能性仍然较低。
