Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.
Hosp Pract (1995). 2022 Oct;50(4):267-272. doi: 10.1080/21548331.2022.2102778. Epub 2022 Jul 22.
Poor communication and lack of standardized handover practices contribute to adverse events. Intensive care organizations recommend standardized, structured written and verbal handover.
Investigate the effectiveness of, and barriers to, Intensive Care Unit (ICU) patient handover at ward transfer. Screen for patient safety incidents related to poor handover and improve practice where deficiencies are identified.
A survey of ward doctors about specific ICU to ward transfers and online surveys ascertaining opinions of handover processes were sent to ward-based and ICU doctors at a large, adult, university affiliated, Australian quaternary hospital. We delivered departmental education and created then publicized a new electronic ICU transfer summary. The summary included a mandatory tick-box to confirm verbal handover completion. Surveys re-assessing practice were then performed.
Forty ward-based doctors were surveyed about specific transfers, with 7 (18%) instances of issues related to handover identified. Eighty-seven ward doctors completed the pre-interventions survey; 48 (55%) were aware of the existing written transfer summary. Post-interventions, 47 (75%) of 63 ward doctor responders were aware of it (p < 0.05). Pre-interventions, 14 (16%) ward doctors rated ICU handovers as excellent or good, rising to 21 (34%) post-interventions (p < 0.05). Thirty-nine ICU doctors completed the pre-interventions survey; 5 (13%) rated ICU to ward handover as excellent or good, rising to 9 (35%) when re-surveyed (p = 0.097).
The perceived quality of ICU to ward handover improved after our interventions. However, ICU doctors continue to transfer patients without verbally handing over, with contacting the ward team representing a significant handover barrier.
沟通不畅和缺乏标准化的交接实践导致了不良事件的发生。重症监护组织建议进行标准化、结构化的书面和口头交接。
调查重症监护病房（ICU）患者在病房转移时交接的效果和障碍。筛查与交接不良相关的患者安全事件，并在发现缺陷时改进实践。
对病房医生进行特定 ICU 到病房转科的调查，并对基于病房和 ICU 的医生进行在线调查，以了解他们对交接流程的看法。我们在一家大型成人、大学附属的澳大利亚四级医院提供了部门教育，并创建了一个新的电子 ICU 转科摘要。该摘要包括一个强制性的勾选框，以确认口头交接的完成。然后进行了重新评估实践的调查。
对 40 名病房医生进行了特定转科的调查，发现了 7 例（18%）与交接相关的问题。87 名病房医生完成了干预前的调查；48 名（55%）知道现有的书面转科摘要。干预后，63 名病房医生中的 47 名（75%）知道它（p<0.05）。干预前，14 名（16%）病房医生将 ICU 交接评为优秀或良好，干预后上升至 21 名（34%）（p<0.05）。39 名 ICU 医生完成了干预前的调查；5 名（13%）将 ICU 到病房的交接评为优秀或良好，再次调查时上升至 9 名（35%）（p=0.097）。
在我们的干预措施之后，ICU 到病房交接的质量得到了提高。然而，ICU 医生在转科时仍不进行口头交接，与病房团队联系是交接的一个主要障碍。
