开发一种新的灵活的交接工具。

Developing a new flexible tool for handover.

机构信息

Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel.

Department of Quality and Safety, Asaf Haroffe Medical Center, Rishon-Le-Zion, Israel.

出版信息

Int J Qual Health Care. 2021 Feb 20;33(1). doi: 10.1093/intqhc/mzab022.

DOI:10.1093/intqhc/mzab022

PMID:33528499

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7928879/

Abstract

BACKGROUND

Transferring medical information among professionals and between shifts is a crucial process, allowing continuity of care and safety, especially for complex patients in life-threatening situations. This process, handover, requires focusing on specific, essential medical information while filtering out redundant and unnecessary details.

OBJECTIVES

To create and implement a tool for handover that would be flexible enough to meet the unique needs of specific departments.

METHODS

We used Plan-Do-Study-Act (PDSA) methodology to prospectively develop, implement, evaluate and reassess a new handover tool in a 900-bed teaching hospital in central Israel. Nurses from 35 departments participated in developing a tool that presents the staff's viewpoint regarding the most critical information needed for handover.

RESULTS

A total of 78 nurse managers and 15 doctors (63.7%) completed the questionnaire. Based on exploratory factor analysis, 15 items explained 58.9% of the variance. Four key areas for handover were identified, in addition to basic patient identification: (i) updated clinical status, (ii) medical information, (iii) special clinical treatment and (iv) treatments not yet initiated. Subsequently, a Flexible Handover Structured Tool (FAST) was designed that identifies patients' needs and is flexible for the specific needs of departments. Revisions based on hands-on experience led to high nurse satisfaction with the new tool in most departments. The FAST format was adopted easily during the COVID-19 pandemic.

CONCLUSION

Implementing a new handover tool-FAST-was challenging, but rewarding. Using PDSA methodology enabled continuous monitoring, oversight and adaptive corrections for better implementation of this new handover reporting tool.

摘要

背景

在专业人员之间以及轮班时转移医学信息是一个关键过程，可确保护理的连续性和安全性，尤其是对于处于危及生命情况的复杂患者。这一过程，即交接班，需要专注于特定的、必要的医疗信息，同时过滤掉冗余和不必要的细节。

目的

创建和实施一种交接班工具，使其具有足够的灵活性，以满足特定部门的独特需求。

方法

我们使用计划-执行-研究-行动（PDSA）方法，在以色列中部的一家 900 床教学医院前瞻性地开发、实施、评估和重新评估一种新的交接班工具。来自 35 个部门的护士参与开发了一种工具，该工具展示了员工对交接班所需最关键信息的观点。

结果

共有 78 名护士长和 15 名医生（63.7%）完成了问卷调查。基于探索性因素分析，15 个项目解释了 58.9%的方差。确定了除基本患者识别以外的四个交接班关键领域：（i）更新的临床状况，（ii）医疗信息，（iii）特殊临床治疗和（iv）尚未开始的治疗。随后，设计了一种灵活的交接班结构化工具（FAST），该工具可识别患者的需求，并灵活适应部门的特定需求。根据实际经验进行的修订导致大多数部门的护士对新工具的满意度很高。在 COVID-19 大流行期间，FAST 格式很容易被采用。