Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Ann Surg. 2020 Mar;271(3):484-493. doi: 10.1097/SLA.0000000000003137.
To assess the effectiveness of standardizing operating room (OR) to intensive care unit (ICU) handoffs in a mixed surgical population.
Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other surgical contexts.
This prospective interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs in 2 affiliated hospitals. From 2014 to 2016, we developed, implemented, and assessed the effectiveness of a new standardized handoff protocol requiring bedside clinician communication using an information template. The primary study outcome was number of information omissions out of 13 possible topics, recorded by trained observers. Data were analyzed using descriptive statistics, bivariate analyses, and multivariable regression.
We observed 165 patient transfers (68 pre-, 97 postintervention). Before standardization, observed handoffs had a mean 4.7 ± 2.9 information omissions each. After standardization, information omissions decreased 21.3% to 3.7 ± 1.9 (P = 0.023). In a pre-specified subanalysis, information omissions for new ICU patients decreased 36.2% from 4.7 ± 3.1 to 3.0 ± 1.6 (P = 0.008, interaction term P = 0.008). The decrement in information omissions was linearly associated with the number of protocol steps followed (P < 0.001). After controlling for patient stability, the intervention was still associated with reduced omissions. Handoff duration increased after standardization from 4.1 ± 3.3 to 8.0 ± 3.9 minutes (P < 0.001). ICU mortality and length of stay did not change postimplementation.
Standardizing OR to ICU handoffs significantly improved information exchange in 2 mixed surgical ICUs, with a concomitant increase in handoff duration. Additional research is needed to identify barriers to and facilitators of handoff protocol adherence.
评估在混合外科人群中标准化手术室（OR）与重症监护病房（ICU）交接的效果。
标准化 OR 与 ICU 交接可改善心脏手术后的信息传递，但在其他外科环境中的证据有限。
这是一项前瞻性干预性队列研究（NCT02267174），在 2 家附属医院的 2 个外科 ICU 中进行。从 2014 年到 2016 年，我们开发、实施并评估了一种新的标准化交接协议的效果，该协议要求使用信息模板进行床边临床医生沟通。主要研究结果是 13 个可能主题中信息遗漏的数量，由经过培训的观察者记录。使用描述性统计、双变量分析和多变量回归分析数据。
我们观察了 165 例患者的转科（68 例在标准化前，97 例在标准化后）。在标准化之前，观察到的交接平均每个有 4.7±2.9 项信息遗漏。标准化后，信息遗漏减少了 21.3%，降至 3.7±1.9（P=0.023）。在预先指定的亚分析中，新 ICU 患者的信息遗漏从 4.7±3.1 减少到 3.0±1.6（P=0.008，交互项 P=0.008）。信息遗漏的减少与遵循的协议步骤数量呈线性相关（P<0.001）。在控制患者稳定性后，干预措施仍与遗漏减少相关。标准化后交接时间从 4.1±3.3 增加到 8.0±3.9 分钟（P<0.001）。实施后 ICU 死亡率和住院时间没有变化。
在 2 个混合外科 ICU 中，标准化 OR 与 ICU 交接显著改善了信息交换，同时交接时间也相应增加。需要进一步研究以确定交接协议遵守的障碍和促进因素。
