Obstetrics and Gynaecology, St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, UK
Old Age Psychiatry, UCL, Division of Psychiatry, London, UK.
BMJ Open Qual. 2022 Mar;11(1). doi: 10.1136/bmjoq-2021-001627.
Efficient handover of patient care is integral to clinical safety. Barriers in communication can lead to adverse outcomes. The Integrated Liaison Assessment Team (ILAT) has a daily handover meeting which presents several challenges to the multidisciplinary liaison team (MDT including high patient turnover, differing staff shift-work patterns, presence of visitors/students and lack of a unified approach to structured discussion at times. Areas identified for improvement included optimising efficiency, structure and handover documentation. Lack of teaching and learning opportunities were also identified. The primary aim was to reduce handover time to 30 min. The secondary aims were to improve communication by introducing the Situation-Background-Assessment-Recommendation (SBAR) tool, improve team satisfaction and introduce a teaching programme in the time saved. The Model for Improvement methodology was used with MDT focus groups and questionnaires to explore change ideas. This informed our 'Plan, Do, Study, Act' cycles to design a structured handover. Daily measures looked at handover length and individual team member satisfaction. Weekly measures included semiqualitative questionnaires highlighting areas for improvement. Feedback was gathered from emails and MDT discussions. A structured handover format incorporating SBAR, key task allocation and a shift handover lead was introduced. A regular MDT teaching programme was initiated. Over 4 weeks, 'Good' handover ratings increased from 22% to 65%; 'Poor' ratings decreased from 25% to 8%. Mean handover time decreased from 47 min to 31.25 min; a decrease of 33.5%. Overall, the team viewed SBAR positively as an efficiency-promoting tool. Structured handover has promoted staff competencies, team morale and information sharing practices among ILAT. MDT teaching improved team communication and confidence. Sustaining motivation to keep up interventions and documentation of handover were identified as key areas for sustained improvement.
患者护理的有效交接是临床安全的重要组成部分。沟通障碍可能导致不良后果。综合联络评估小组（ILAT）每天都有交接会议，这给多学科联络小组（MDT）带来了几个挑战，包括患者周转率高、工作人员轮班模式不同、有访客/学生在场以及有时缺乏结构化讨论的统一方法。确定需要改进的领域包括提高效率、结构和交接文件。还确定了缺乏教学和学习机会。主要目标是将交接时间减少到 30 分钟。次要目标是通过引入情况-背景-评估-建议（SBAR）工具来改善沟通，提高团队满意度，并在节省的时间内引入教学计划。使用 MDT 焦点小组和问卷调查来探索改进想法，采用改进模型方法。这为我们设计结构化交接的“计划、执行、研究、行动”循环提供了信息。每日措施着眼于交接时间和个别团队成员的满意度。每周措施包括半定性问卷，突出改进领域。从电子邮件和 MDT 讨论中收集反馈。引入了一种包含 SBAR、关键任务分配和轮班交接负责人的结构化交接格式。并启动了定期的 MDT 教学计划。在 4 周内，“良好”的交接评级从 22%增加到 65%；“差”的评级从 25%下降到 8%。平均交接时间从 47 分钟减少到 31.25 分钟，减少了 33.5%。总的来说，团队积极看待 SBAR 作为提高效率的工具。结构化交接提高了 ILAT 工作人员的能力、团队士气和信息共享实践。MDT 教学提高了团队的沟通能力和信心。维持改进的动力，包括保持干预措施和交接文件记录，被确定为持续改进的关键领域。
