阿根廷儿科重症监护病房交接改进和不良事件减少计划的实施：一项阶梯式试验。

Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: a stepped-wedge trial.

机构信息

Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina

PICU, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.

出版信息

BMJ Qual Saf. 2021 Oct;30(10):782-791. doi: 10.1136/bmjqs-2020-012370. Epub 2021 Apr 23.

DOI:10.1136/bmjqs-2020-012370

PMID:33893213

Abstract

BACKGROUND

There are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes' effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs).

METHODS

Facility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation.

RESULTS

We reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5-97.4) vs intervention 60.4 (33.2-109.9), p=0.99, risk ratio: 1.0 (0.74-1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6-41.8) vs intervention 34.7 min (26.5-42.1); difference 1.43 min (95% CI -2.63 to 5.49, p=0.49)). The providers' perception of improved communication did not change.

CONCLUSIONS

After the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs' frequency or the perception of enhanced communication.

TRIAL REGISTRATION NUMBER

NCT03924570.

摘要

背景

仅有少数研究严格评估交接班质量和不良事件（AE），以评估交接班改进计划的有效性。这些研究均未在中低收入国家开展。我们旨在评估交接班方案的实施对降低儿科重症监护病房（PICU）AE 频率的效果。

方法

这是一项在阿根廷 6 家 PICU 中开展的基于医疗机构、整群、阶梯式随机对照试验，每家 PICU 每月至少有 20 例住院患者。该研究于 2018 年 7 月至 2019 年 5 月进行，所有单位在对照期至少参与 3 个月，在干预期至少参与 4 个月。干预措施包括西班牙语版 I-PASS 交接班工具包，包括使用记忆术的书面和口头交接班、团队培训介绍性讲习班、广告宣传活动、模拟练习、交接班观察和标准化反馈。采用触发工具方法审查病历（MR）以确定 AE（主要结局）。通过直接观察评估交接班的依从性和持续时间。

结果

我们回顾了 1465 份 MR：对照组 767 份，干预组 698 份。我们未观察到住院期间每 1000 天 AE 发生率（对照组 60.4（37.5-97.4）与干预组 60.4（33.2-109.9））的差异（p=0.99，风险比：1.0（0.74-1.34）），AE 类别或类型也未发生变化。我们评估了 841 次交接班：对照组 396 次，干预组 445 次。口头和书面交接班的所有项目的依从性在干预组中均显著更高。两个时期的交接班时间均无差异（对照组 35.7 分钟（29.6-41.8）与干预组 34.7 分钟（26.5-42.1）；差异 1.43 分钟（95%CI-2.63 至 5.49，p=0.49））。提供者对沟通改善的感知没有变化。