Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington; Independent Practice in Los Angeles, California.
Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington.
J Surg Educ. 2019 Jul-Aug;76(4):1048-1067. doi: 10.1016/j.jsurg.2018.12.010. Epub 2019 Apr 3.
The postoperative handover is often compromised by reporting inconsistencies between different specialties. We describe a multidisciplinary quality improvement initiative to improve postoperative information reporting.
A quality improvement project with interrupted time-series data collection was undertaken in the postanesthesia care unit between January 2015 and August 2015. We utilized Six Sigma methodology to engage multispecialty stakeholders in identifying deficiencies in the existing postoperative handover process in January 2015. A standardized handover process including a checklist and electronic handover note was implemented within a postanesthesia care unit in June 2015. Direct observations of handovers were conducted to determine reporting accuracy, handover duration, and specialty representative attendance. Segmented linear and logistic regression analyses were used for interrupted time-series data.
Single postanesthesia care unit at an academic tertiary referral center.
Physician trainees in anesthesia (n = 82) and surgical subspecialties (n = 139), certified registered nurse anesthetists (n = 57), and recovery room registered nurses (n = 139).
Cumulative handover scores increased by 18.3 points in the postimplementation period (n = 70) when compared to preimplementation handovers (n = 69), a finding which remained statistically significant after adjusting for preintervention time trends (difference 16 points; 95% confidence intervals 3-31; p = 0.021). No statistically significant difference in handover duration was seen between cohorts (6.8 minutes vs 6.1 minutes, difference 0.5 minutes; 95% confidence intervals -2.8 to 3.7; p = 0.78). Three years postimplementation, there was consistent use of a modified electronic handover note and surgical subspecialty attendance during handover.
A standardized handover process was associated with improved information reporting among different surgical disciplines without significantly lengthening handover duration.
由于不同专业之间的报告不一致，术后交接常常受到影响。我们描述了一项多学科质量改进计划，以改善术后信息报告。
2015 年 1 月至 2015 年 8 月，在麻醉后护理单元进行了一项质量改进项目，同时收集了中断时间序列数据。我们利用六西格玛方法让多学科利益相关者参与确定 2015 年 1 月现有术后交接流程中的缺陷。2015 年 6 月，在麻醉后护理单元实施了标准化交接流程，包括检查表和电子交接记录。通过直接观察交接情况，确定报告准确性、交接时间和专科代表出席情况。使用分段线性和逻辑回归分析进行中断时间序列数据。
学术三级转诊中心的单一麻醉后护理单元。
麻醉医师实习生（n=82）和外科专科医师（n=139）、认证注册护士麻醉师（n=57）和恢复室注册护士（n=139）。
与实施前交接相比（n=69），实施后交接的累计交接评分增加了 18.3 分（n=70），调整干预前时间趋势后，这一发现仍具有统计学意义（差异 16 分；95%置信区间 3-31；p=0.021）。两组交接时间无统计学差异（6.8 分钟比 6.1 分钟，差异 0.5 分钟；95%置信区间 -2.8 至 3.7；p=0.78）。实施后 3 年，改良电子交接记录和外科专科代表在交接期间持续使用。
标准化交接流程与不同外科专业之间信息报告的改善相关，而不会显著延长交接时间。
