Piper Donella, Lea Jackie, Woods Cindy, Parker Vicki
UNE Business School University of New England, Armidale, NSW, 2351, Australia.
School of Health, University of New England, Armidale, NSW, 2351, Australia.
BMC Health Serv Res. 2018 Nov 26;18(1):889. doi: 10.1186/s12913-018-3708-3.
Effective handover is crucial for patient safety. Rural health care organisations have particular challenges in relation to handover of information, placing them at higher risk of adverse events. Few studies have examined the relationship between handover and patient safety in rural contexts, particularly in Australia. This study aimed to explore the effect of handover on overall perceptions of patient safety and the effect of other patient safety dimensions on handover in a rural Australian setting.
A cross-sectional online survey using The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was implemented across six rural Local Health Districts in NSW, Australia and resulted in 1587 respondents. Hierarchical multiple linear regression analysis was conducted to account for the nested nature of the data. Models were developed to assess the effect of handover on patient safety perceptions, and the effect of other patient safety culture composites on handover variables. Open-ended questions about patient safety were inductively analyzed for themes. Quotes from the handover theme are presented.
All models were significant overall (p < .001), with explanatory powers ranging from 29 to 48%. Within rural health settings, effective handover is significantly related to patient safety perceptions (R = .29). A strong teamwork culture and management support culture was found to enhance effective handover of patient information (R = .47), and effective handover of personal responsibility (R = .37). A strong teamwork, management support, and open communication culture enhances handover of department accountability (R = .41). Despite the implementation of standardised communication tools and frameworks for handover, patient safety is compromised by inadequate coordination, poor or absent documentation between departments, between other health care agencies and in transfer of care from acute facilities to primary/community care.
Approaches to handover need to consider the particular challenges associated with rurality and strengthening elements found to be associated with increased safety, such as a strong teamwork and management culture and good reporting practices. Research is required to examine how communication at transition of care, particularly between facilities, is conducted and ways in which to enhance patients' and families' participation.
有效的交接班对于患者安全至关重要。农村医疗保健机构在信息交接方面面临特殊挑战，这使它们面临更高的不良事件风险。很少有研究探讨农村地区（尤其是在澳大利亚）交接班与患者安全之间的关系。本研究旨在探讨在澳大利亚农村地区，交接班对患者安全总体认知的影响以及其他患者安全维度对交接班的影响。
在澳大利亚新南威尔士州的六个农村地方卫生区开展了一项横断面在线调查，该调查使用了医疗保健研究与质量局的医院患者安全文化调查，共有1587名受访者。进行了分层多元线性回归分析，以考虑数据的嵌套性质。建立模型以评估交接班对患者安全认知的影响，以及其他患者安全文化综合指标对交接班变量的影响。对有关患者安全的开放式问题进行归纳分析以找出主题。给出了交接班主题的引述。
所有模型总体上均具有显著性（p <.001），解释力范围为29%至48%。在农村卫生环境中，有效的交接班与患者安全认知显著相关（R =.29）。发现强大的团队合作文化和管理支持文化可增强患者信息的有效交接（R =.47）以及个人责任的有效交接（R =.37）。强大的团队合作、管理支持和开放沟通文化可增强部门问责制的交接（R =.41）。尽管实施了标准化的交接班沟通工具和框架，但由于协调不足、部门之间以及其他医疗保健机构之间文档不完善或缺失，以及在从急性医疗机构向初级/社区护理的护理转移过程中，患者安全受到了损害。
交接班方法需要考虑与农村地区相关的特殊挑战，并强化那些被发现与提高安全性相关的因素，如强大的团队合作和管理文化以及良好的报告做法。需要进行研究，以检查在护理过渡期间（尤其是机构之间）的沟通方式以及增强患者和家属参与度的方法。
