儿科非心脏手术室与重症监护病房交接的标准化可改善沟通和患者护理。
Standardization of Pediatric Noncardiac Operating Room to Intensive Care Unit Handoffs Improves Communication and Patient Care.
机构信息
From the Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston.
Children's Memorial Hermann Hospital.
出版信息
J Patient Saf. 2022 Sep 1;18(6):e1021-e1026. doi: 10.1097/PTS.0000000000000986. Epub 2022 Feb 3.
OBJECTIVES
Handoffs are critical points in transitioning care between multidisciplinary teams, yet data regarding intensive care unit (ICU) handoffs in pediatric noncardiac surgical patients are lacking. We hypothesized that standardized handoffs from the pediatric operating room (OR) to the ICU would improve physician presence, communication, and patient care parameters.
METHODS
This quality improvement initiative was performed at a tertiary children's hospital. Stakeholders (anesthesiologists, nurses, intensivists, and surgeons) developed a standardized OR to pediatric and neonatal ICU handoff process based on common goals and outcomes of interest. Baseline data were collected before intervention. Implementation was carried out in 2 phases, phase 1 with a written handoff and Phase 2 with a scripted handoff process. Data collected by trained observers included handoff attendance, distractions, and transfer of essential patient information. As a surrogate for outcomes, patient care parameter data were collected for 6 hours after transfer.
RESULTS
After phase 1, surgery and ICU physician attendance increased significantly, distractions decreased, and communication of essential patient data improved. In phase 2 (scripted handoff), attendance continued to rise, distractions remained decreased, and transfer of essential information was still improved compared with baseline. Mean handoff duration did not significantly change throughout the study. Certain patient care parameters (escalation of respiratory support, additional laboratory studies, vasopressor administration, antibiotic administration and timing) remained unchanged compared with baseline. However, the need for resuscitative fluid bolus or blood products significantly decreased after implementation phase 2.
CONCLUSIONS
Standardized handoffs for pediatric noncardiac surgical patients from the OR to the ICU can improve provider attendance and communication.
目的
交接班是多学科团队之间交接护理的关键环节，但儿科非心脏手术患者的重症监护病房（ICU）交接班数据却十分缺乏。我们假设从儿科手术室（OR）到 ICU 的标准化交接班将改善医生的到场情况、沟通情况和患者护理参数。
方法
这是一项在三级儿童医院进行的质量改进计划。利益相关者（麻醉师、护士、重症监护医生和外科医生）根据共同的目标和关注的结果，制定了儿科 OR 到儿科和新生儿 ICU 的标准化交接班流程。在干预之前收集基线数据。实施分两个阶段进行，第 1 阶段采用书面交接班，第 2 阶段采用脚本化交接班流程。由经过培训的观察者收集的资料包括交接班出席情况、干扰情况以及关键患者信息的传递。作为结果的替代指标，在转移后收集了 6 小时的患者护理参数数据。
结果
在第 1 阶段之后，手术和 ICU 医生的出席率显著增加，干扰减少，关键患者数据的沟通得到改善。在第 2 阶段（脚本式交接班），出席率继续上升，干扰情况仍然减少，关键信息的传递与基线相比仍有改善。整个研究过程中，交接班的平均持续时间没有显著变化。某些患者护理参数（呼吸支持的升级、额外的实验室研究、血管加压药的使用、抗生素的使用和时间）与基线相比没有变化。然而，在实施第 2 阶段后，复苏液晶体液或血制品的需求显著减少。
结论
为儿科非心脏手术患者从 OR 到 ICU 的交接班进行标准化，可以改善医护人员的到场情况和沟通情况。
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