Alrajhi Khaled, Alsaawi Abdulmohsen
Department of Emergency Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, King Abdulaziz Medical City, Mail Code: 1428, P.O. Box 22490, Riyadh, 11428, Kingdom of Saudi Arabia.
Int J Emerg Med. 2019 Nov 21;12(1):37. doi: 10.1186/s12245-019-0249-4.
Handoffs at the end of clinical shifts occur with high frequencies in the emergency department setting and they pose an increased risk to patients. There is a need to standardize handoff practices. This study aimed to use an electronic Delphi method to identify the core elements essential for an emergency department physician to physician handoff and propose a framework for implementation.
An electronic Delphi-style study with a national panel of board-certified emergency physicians in Saudi Arabia. The panel was conducted over four rounds. The first to identify elements relevant to the end of shift handoff and categorize them into domains, while the remaining three to score and debate individual elements.
Twenty-five board-certified emergency physicians from various cities and practice settings were enrolled. All panelists completed the entire Delphi process. Thirty-two elements were identified and classified into 4 domains. The top five rated handoff elements were patient identification, chief complaint history, clinical stability, working diagnosis, and consulting services involved. Panel scores showed convergence as rounds progressed and the final list of elements had a high-reliability score (Cronbach's alpha 0.93).
This study yielded an itemized and ranked list of elements that are easy to implement and could be used to standardize patient handoffs by emergency physicians. While this study was conducted on an emergency medicine panel, the methods used may be adapted to develop standardized handoff frameworks that serve different disciplines or practice settings.
在急诊科环境中，临床轮班结束时的交接班频繁发生，这给患者带来了更高的风险。因此，需要规范交接班流程。本研究旨在运用电子德尔菲法，确定急诊科医生之间交接班的核心要素，并提出一个实施框架。
对沙特阿拉伯全国范围内获得董事会认证的急诊科医生组成的专家小组进行电子德尔菲式研究。该小组共进行四轮。第一轮用于确定与轮班结束时交接班相关的要素，并将其分类到不同领域，而后三轮用于对各个要素进行评分和讨论。
招募了来自不同城市和医疗机构的25名获得董事会认证的急诊科医生。所有小组成员均完成了整个德尔菲过程。确定了32个要素，并将其分为4个领域。评分最高的五个交接班要素是患者识别、主诉病史、临床稳定性、初步诊断以及涉及的会诊服务。随着轮次的推进，小组成员的评分趋于一致，最终的要素清单具有较高的可靠性评分（克朗巴哈系数为0.93）。
本研究得出了一份详细且排名清晰的要素清单，易于实施，可用于规范急诊科医生的患者交接流程。虽然本研究是针对急诊医学专家小组开展的，但所采用的方法可加以调整，以制定适用于不同学科或医疗机构的标准化交接框架。
