Kulesa John T, Balsara Sheri L, Ghebremariam Emanuel T, Colyer Jessica
Children's National Medical Center, Washington, D.C.
Pediatr Qual Saf. 2020 May 18;5(3):e300. doi: 10.1097/pq9.0000000000000300. eCollection 2020 May-Jun.
Patient transitions create vulnerability for care teams. Failures in the handoff process result in communication errors and knowledge gaps, mainly when the handoff occurs between resident and expert-level subspecialty clinicians. The authors set out to develop a standardized handoff using resident comfort as a proxy for implementation. The primary measurable aim of this study was to increase the percentage of pediatric residents who self-reported comfort in assuming care of patients transitioned from the cardiac intensive care unit to the cardiology acute care unit.
Investigators surveyed residents at a 323-bed pediatric hospital on their handoff experiences. The study team performed a Failure Mode Effect Analysis and created a key driver diagram. Interventions included a transfer checklist and algorithm, a huddle between care teams, and education surrounding the transfer process.
Residents completed a survey before (n = 74) or after (n = 23) intervention. The percentage of residents who reported feeling "always" or "very often" prepared to care for patients at the time of transfer increased from 15% to 83%. The percentage of residents who reported that they "always" or "very often" had concerns about floor appropriateness decreased from 23% to 4%.
The authors designed a transfer process to improve communication, resident-level education, and psychological safety among team members to ensure safe, thorough handoffs between providers with different levels of training. Although we cannot definitively conclude that resident comfort improved due to a small "n" postintervention, we offer a description outlining process changes, barriers to implementation, and lessons learned.
患者交接会给护理团队带来风险。交接过程中的失误会导致沟通错误和知识缺口，尤其是在住院医师与专家级专科临床医生之间进行交接时。作者着手开发一种标准化交接方式，并以住院医师的舒适度作为实施的衡量标准。本研究的主要可衡量目标是提高自认为能够安心护理从心脏重症监护病房转至心脏病急性护理病房患者的儿科住院医师比例。
研究人员对一家拥有323张床位的儿科医院的住院医师进行了关于交接经历的调查。研究团队进行了失效模式与效应分析，并绘制了关键驱动因素图。干预措施包括一份转科清单和算法、护理团队之间的简短碰头会以及围绕转科流程的培训。
住院医师在干预前（n = 74）或干预后（n = 23）完成了一项调查。报告在转科时“总是”或“非常经常”做好护理患者准备的住院医师比例从15%增至83%。报告“总是”或“非常经常”担心病房适配性的住院医师比例从23%降至4%。
作者设计了一种转科流程，以改善沟通、住院医师层面的培训以及团队成员间的心理安全感，确保不同培训水平的医护人员之间能够进行安全、全面的交接。尽管由于干预后的样本量较小，我们无法确切得出住院医师舒适度有所提高的结论，但我们提供了一份描述，概述了流程变化、实施障碍以及经验教训。
