St. Luke's University Health Network, Department of Emergency Medicine, Bethlehem, Pennsylvania.
St. Luke's University Health Network, Research Institute, Department of Emergency Medicine, Bethlehem, Pennsylvania.
West J Emerg Med. 2019 Jan;20(1):29-34. doi: 10.5811/westjem.2018.10.39020. Epub 2018 Nov 20.
Transitions of patient care during physicians' change of shift introduce the potential for critical information to be missed or distorted, resulting in possible morbidity. The Joint Commission, the Accreditation Council for Graduate Medical Education, and the Society of Hospital Medicine jointly encourage a structured format for patient care sign-out. This study's objective was to examine the impact of a standardized checklist on the quality of emergency medicine (EM) resident physicians' patient-care transition at shift change.
Investigators developed a standardized sign-out checklist for EM residents to complete prior to sign out. This checklist included topics of diagnoses, patient-care tasks to do, patient disposition, admission team, and patient code status. Two EM attending physicians, the incoming and departing, assessed the quality of transitions of care at this shift change using a standardized assessment form. This form also assessed overall quality of sign-out using a visual analog scale (VAS), based on a 10-centimeter scale. For two months, we collected initial, status quo data (pre-checklist [PCL] cohort) followed by two months of residents using the checklist (post-checklist [CL] cohort).
We collected data for 77 days (July 1, 2015 - November 11, 2015), 38 days of status quo sign-out followed by 39 days of checklist utilization, comprised of 1,245 attending assessments. Global assessment of sign-out for the CL was 8 compared to 7.5 for the PCL. Aspects of transition of care that implementation of the sign-out checklist impacted included the following (reported as a frequency): "To Do" (PCL 84.3%, CL 97.8%); "Disposition" (PCL 97.2%, CL 99.4%); "Admit Team" (67.1%, CL 76.2%); and "Attending Add" (PCL 23.4%, CL 11.3%).
Implementation of a sign-out checklist enhanced EM resident physician transition of care at shift end by increasing the frequency of discussion of critical tasks remaining for patient care, disposition status, and subjective assessment of quality of sign-out.
医生交接班期间的患者护理交接存在潜在的重要信息遗漏或曲解的风险，可能导致患者出现并发症。联合委员会、研究生医学教育认证委员会和医院医学协会共同鼓励采用结构化的患者交接模式。本研究的目的是检验标准化清单对急诊医学（EM）住院医师交接班时患者护理交接质量的影响。
研究人员为 EM 住院医师制定了标准化的交接清单，以便在交接前完成。该清单包括诊断、待办患者护理任务、患者处置、入院团队和患者编码状态。两名急诊主治医生（接班医生和交班医生）使用标准化评估表评估此次交接班的患者护理交接质量。该评估表还基于 10 厘米的评分标尺，使用视觉模拟评分法（VAS）评估整体交接质量。在两个月的时间里，我们收集了初始数据（无清单阶段[PCL]队列），然后是两个月的住院医师使用清单数据（清单阶段[CL]队列）。
我们共收集了 77 天的数据（2015 年 7 月 1 日-11 月 11 日），其中 38 天为无清单交接，39 天为清单交接，共涉及 1245 次主治医生评估。CL 阶段的整体交接评估为 8 分，而 PCL 阶段为 7.5 分。清单交接的实施影响了交接的以下方面（以频率报告）：“待办事项”（PCL 为 84.3%，CL 为 97.8%）；“处置”（PCL 为 97.2%，CL 为 99.4%）；“入院团队”（67.1%，CL 为 76.2%）；以及“主治添加”（PCL 为 23.4%，CL 为 11.3%）。
实施交接清单提高了 EM 住院医师交接班时对患者护理交接的讨论频率，增加了待办关键任务、处置状态和交接质量的主观评估，从而增强了住院医师的患者护理交接质量。
