Hart Thomas, Samways Jack William, Kukendrarajah Kishore, Keenan Matthew, Chaudhri Saurabh
Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Whipps Cross University Hospital , London, UK.
Int J Health Care Qual Assur. 2018 Aug 13;31(7):845-854. doi: 10.1108/IJHCQA-08-2017-0148.
The Royal College of Surgeons recognises patient handover as the point at which patients are collectively at their most vulnerable. Concerns were raised in a London teaching hospital surgical department regarding an unstructured handover system, poor access to relevant clinical information, and inadequate weekend staffing. A quality improvement programme was designed and implemented to respond to these concerns and improve patient safety. The paper aims to discuss these issues.
DESIGN/METHODOLOGY/APPROACH: A structured questionnaire was distributed to staff and results used to construct a diagram outlining the main factors influencing weekend patient safety. This framework was used to design changes, including a new electronic handover tool, regular handover meetings and additional weekend staff. Regular staff training was provided, and success was assessed in a continuous audit cycle with the results fed back to team leaders.
Over a three-month period, the handover meeting recorded an attendance rate consistently above 80 per cent. The electronic handover entries were scored according to seven criteria (correct layout; key information, i.e.: patient location, clinical priority, active issues, resuscitation status, test results and weekend plan), averaging between 42.2 and 92.9 per cent, with progressive improvement seen over the assessment period. Weekend staffing was increased by 50 per cent, allowing a dedicated team to care for stable inpatients and to oversee discharges.
ORIGINALITY/VALUE: This improvement programme delivered lasting and significant change in response to staff concerns. It resulted in a more structured and reliable weekend system and established key mechanisms for dynamic performance feedback.
皇家外科医学院认识到患者交接是患者集体最脆弱的时刻。伦敦一家教学医院的外科部门对无组织的交接系统、获取相关临床信息困难以及周末人员配备不足表示担忧。设计并实施了一项质量改进计划，以回应这些担忧并提高患者安全。本文旨在讨论这些问题。
设计/方法/途径：向工作人员发放了一份结构化问卷，结果用于构建一个概述影响周末患者安全的主要因素的图表。该框架用于设计变革，包括新的电子交接工具、定期交接会议和额外的周末工作人员。提供了定期的员工培训，并在持续的审核周期中评估成功情况，结果反馈给团队领导。
在三个月的时间里，交接会议的出勤率一直高于80%。电子交接记录根据七个标准（正确布局；关键信息，即：患者位置、临床优先级、当前问题、复苏状态、检查结果和周末计划）进行评分，平均在42.2%至92.9%之间，在评估期间呈逐步改善趋势。周末人员配备增加了50%，使得有一个专门的团队来照顾病情稳定的住院患者并监督出院情况。
原创性/价值：这项改进计划针对工作人员的担忧带来了持久而重大的改变。它形成了一个更有条理、更可靠的周末系统，并建立了动态绩效反馈的关键机制。
