Cooney Hannah J, Banbury Hannah E, Plunkett Adrian C
Teaching Fellowship, Russell Hall Hospital, Dudley Group NHS Foundation Trust, United Kingdom.
Department of Emergency Medicine, Sunshine Coast University Hospital, Queensland, Australia.
Pediatr Qual Saf. 2018 Apr 9;3(2):e074. doi: 10.1097/pq9.0000000000000074. eCollection 2018 Mar-Apr.
Timely communication is essential in the intensive care environment. Delays may occur if communication relies on identification of individuals through line of sight, or use of telephones and pagers. We measured communication delays, staff perceptions, and clinical outcomes before and after implementation of a hands-free wireless communication device (HWCD) in a pediatric intensive care unit (PICU).
Single-center study comprising 3 components: observational study of verbal communication among PICU staff; staff survey regarding perceptions of communication delays; analysis of clinical data (length of stay, risk adjusted mortality, emergency events). All components were conducted before and after implementation of the HWCD.
Four hundred sixteen hours of staff working time were observed (210 pre- and 206 postimplementation). These data showed significant reduction in communication delays-most notably among roaming staff [median time to response to verbal queries before and after implementation 120 seconds (interquartile range, 6-255) and 9 seconds (interquartile range, 7-30), respectively: < 0.001]. The results of the staff survey showed significant improvements in staff perceptions of communication delays in all roaming staff groups utilizing the HWCD. The survey response rate was 205/361: 56.8%. There were no differences in clinical outcomes from the routinely collected clinical data. There was a significant reduction in emergency event rate-emergency summoning of assistance to bedside (per 100 bed-days)-before and after implementation, 2.17 and 1.69, respectively: rate ratio = 0.78 (95% confidence interval, 0.63-0.95; < 0.05).
Implementation of a HWCD was associated with significant reduction in communication delays among roaming staff members in PICU.
在重症监护环境中，及时沟通至关重要。如果沟通依赖于通过视线识别人员，或使用电话和传呼机，可能会出现延迟。我们在一家儿科重症监护病房（PICU）实施免提无线通信设备（HWCD）前后，测量了沟通延迟、工作人员的看法以及临床结果。
单中心研究包括三个部分：对PICU工作人员之间言语沟通的观察性研究；关于沟通延迟看法的工作人员调查；临床数据（住院时间、风险调整死亡率、紧急事件）分析。所有部分均在HWCD实施前后进行。
观察了416小时的工作人员工作时间（实施前210小时，实施后206小时）。这些数据显示沟通延迟显著减少——最明显的是在流动工作人员中[实施前后对口头询问的中位响应时间分别为120秒（四分位间距，6 - 255）和9秒（四分位间距，7 - 30）：<0.001]。工作人员调查结果显示，在所有使用HWCD的流动工作人员组中，工作人员对沟通延迟的看法有显著改善。调查回复率为205/361：56.8%。常规收集的临床数据中的临床结果没有差异。紧急事件率显著降低——床边紧急呼叫援助（每100床日）——实施前后分别为2.17和1.69：率比 = 0.78（95%置信区间，0.63 - 0.95；<0.05）。
在PICU中，HWCD的实施与流动工作人员之间的沟通延迟显著减少有关。
