麻醉住院医师培训如何塑造住院医师对患者交接的处理方式？一项单中心定性访谈研究。

How does training in anesthesia residency shape residents' approaches to patient care handoffs? A single-center qualitative interview study.

机构信息

Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA, 19104, USA.

Penn Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

BMC Med Educ. 2018 Nov 20;18(1):271. doi: 10.1186/s12909-018-1387-8.

DOI:10.1186/s12909-018-1387-8

PMID:30458779

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6245869/

Abstract

BACKGROUND

Handoffs are a complex procedure whose success relies on mutual discussion rather than simple information transfer. Particularly among trainees, handoffs present major opportunities for medical error. Previous research has explored best practices and pitfalls in general handoff education but has not discussed barriers specific to anesthesiology residents. This study characterizes the experiences of residents in anesthesiology as they learn handoff technique in order to inform strategies for teaching this important component of perioperative care.

METHODS

In 2016, we conducted a semi-structured interview study of 30 anesthesia residents across all three postgraduate years at a major academic hospital. Interviews were coded by two coders using a grounded theory approach and an iterative process designed to enhance reliability and validity.

RESULTS

Residents cited lack of consistency as a major impediment to proper handoff education. They found the impact of lectures and written materials to be limited. The level of guidance and direction they received from one-to-one attendings was described as highly variable. Residents' comfort in executing handoffs was heavily dependent on location and situation. They felt that coordination among the parties involved in the handoff was difficult to achieve, causing confusion about the importance of handoffs as well as proper protocol. Finally, residents offered opinions on when handoff education should occur during the residency and had several recommendations for its improving, including standardization of key handoff topics.

CONCLUSIONS

In a single center study of anesthesiology resident handoff education, residents exhibited confusion related to a perceived disconnect between the stated importance of effective handoffs and a lack of consensus on proper handoff technique. Standardization of curriculum and framing expectations has the potential to enhance resident handoff training in academic anesthesia departments.

摘要

背景

交接班是一项复杂的程序，其成功依赖于双方的讨论，而不仅仅是简单的信息传递。尤其是在培训医师中，交接班存在着导致医疗差错的重大风险。先前的研究探讨了一般交接班教育中的最佳实践和陷阱，但并未讨论麻醉住院医师特有的障碍。本研究描述了麻醉住院医师在学习交接班技术时的经验，以便为教授围手术期护理这一重要环节提供策略。

方法

2016 年，我们在一家主要学术医院对所有三个研究生年级的 30 名麻醉住院医师进行了半结构化访谈研究。访谈由两位编码员使用扎根理论方法进行编码，并采用迭代过程设计，以增强可靠性和有效性。

结果

住院医师提到缺乏一致性是正确交接班教育的主要障碍。他们发现讲座和书面材料的影响有限。他们从一对一主治医生那里获得的指导和方向被描述为高度可变。住院医师执行交接班的舒适度在很大程度上取决于地点和情况。他们认为交接班各方之间的协调很难实现，导致对交接班的重要性以及适当的规范产生混淆。最后，住院医师就住院医师期间应该进行交接班教育发表了意见，并提出了一些改进建议，包括关键交接班主题的标准化。