Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA.
BMJ Qual Saf. 2021 Jun;30(6):513-524. doi: 10.1136/bmjqs-2020-012474. Epub 2021 Feb 9.
To conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.
We included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.
32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=-42.51 min, 95% CI -60.39 to -24.64), fewer information omissions (MD=-2.22, 95% CI -3.68 to -0.77), fewer technical errors (MD=-2.38, 95% CI -4.10 to -0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.
Bundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.
系统回顾和荟萃分析确定手术室（OR）到重症监护病房（ICU）交接干预措施对基于流程和临床结果的影响。
我们纳入了所有以英文发表并在同行评议期刊上作为原始研究文章出版的 OR 到 ICU 交接干预前瞻性评估研究。检索于 2019 年 11 月 11 日在 MEDLINE、CINAHL、EMBASE、Scopus 和 Cochrane 对照试验中心注册库进行，未预先规定比较类型或结果的标准。使用随机效应模型对类似结果进行荟萃分析。使用改良的 Downs 和 Black（D&B）清单评估质量。
有 32 项研究被纳入综述。31 项研究在单一地点进行，28 项研究采用观察性研究设计并设有对照组。大多数研究（n=28）评估了包含信息传递/沟通检查表和方案的综合干预措施。荟萃分析显示，交接干预组在镇痛剂量给药时间（平均差值（MD）=-42.51 分钟，95%CI -60.39 至 -24.64）、信息遗漏（MD=-2.22，95%CI -3.68 至 -0.77）、技术错误（MD=-2.38，95%CI -4.10 至 -0.66）和信息共享评分（MD=30.03%，95%CI 19.67%至 40.40%）方面有统计学意义的改善。在 32 项研究中，仅有 15 项研究在改良的 D&B 清单上得分超过 9 分，表明缺乏高质量的研究。
综合干预措施常用于支持 OR 到 ICU 交接的标准化。尽管荟萃分析显示在许多临床和流程结果方面有显著改善，但在解释这些发现时必须考虑到统计学和临床异质性。讨论了对 OR 到 ICU 交接实践和未来研究的影响。
