Carson Joseph, Gottheil Stephanie, Dyck Bailey, Rice Tim
Jt Comm J Qual Patient Saf. 2019 Oct;45(10):711-716. doi: 10.1016/j.jcjq.2019.08.001. Epub 2019 Sep 5.
Interprofessional hospital communication is vital for high-quality patient care. However, staff have reported that nursing pages are often sent to the wrong residents, leading to service delays, interruptions, and safety risks. The aim of this quality improvement project was to reduce day shift pages to general internal medicine (GIM) teams by 25% over 10 months by helping nurses page the right residents the first time.
This study was conducted at a Canadian tertiary academic hospital and involved three GIM teams on seven inpatient wards. The Model for Improvement was used to explore root causes and redesign how nurses and switchboard operators contacted residents. Multiple change ideas were tested: posting daily resident assignments on digital monitors, redirecting switchboard pages to internal medicine residents, and forwarding pagers in learning sessions. The primary outcome was the average number of pages/team/week to GIM residents. Evaluation was conducted with statistical process control charts and qualitative feedback.
A total of 19,925 pages were reviewed from 226 resident shifts over 39 weeks. Average pages/team/week (Monday to Friday, 08:00 to 17:00) decreased by 38.3% (133 to 82) postimplementation. More nurses reported often or always knowing which residents were assigned to patients, increasing from 0% to 38.1%. Fewer residents reported often or always receiving pages about another resident's patient, decreasing from 50.0% to 26.7%.
Quality improvement methods were used to streamline the paging process on GIM wards, resulting in fewer pages and improved communication efficiency.
跨专业的医院沟通对于高质量的患者护理至关重要。然而，工作人员报告称，护理传呼经常发送给错误的住院医师，导致服务延迟、中断和安全风险。这个质量改进项目的目标是通过帮助护士首次准确传呼正确的住院医师，在10个月内将白天班次发给普通内科（GIM）团队的传呼减少25%。
本研究在一家加拿大三级学术医院进行，涉及七个住院病房的三个GIM团队。采用改进模型来探究根本原因，并重新设计护士和总机接线员与住院医师联系的方式。测试了多个改进想法：在数字显示器上张贴每日住院医师任务安排、将总机传呼转接给内科住院医师以及在学习课程中转发传呼机。主要结果是发给GIM住院医师的平均传呼次数/团队/周。使用统计过程控制图和定性反馈进行评估。
在39周内对226个住院医师班次的总共19925次传呼进行了审查。实施后，平均传呼次数/团队/周（周一至周五，08:00至17:00）下降了38.3%（从133次降至82次）。更多护士报告经常或总是知道哪些住院医师被分配给了患者，这一比例从0%增加到38.1%。更少的住院医师报告经常或总是收到关于其他住院医师患者的传呼，这一比例从50.0%降至26.7%。
采用质量改进方法简化了GIM病房的传呼流程，减少了传呼次数，提高了沟通效率。
