Fazzini Brigitta, McGinley Ann, Stewart Carolyne
Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.
Critical Care Outreach Team, Royal London Hospital, Whitechapel Road, E1 1FR London, UK.
Intensive Crit Care Nurs. 2023 Feb;74:103331. doi: 10.1016/j.iccn.2022.103331. Epub 2022 Oct 5.
Safety briefings can help promoting situational awareness, interprofessional communication and improve patient safety.
A clinical survey highlighted that 90% of the participants including the medical team and the critical care outreach team nurses perceived the meeting for escalating acutely ill and deteriorating patients during the out-of-hours period (20.00 to 08.00) to have unconstructive and unwelcoming atmosphere with belittling, hostility and unhelpful criticisms. The participants reported that the communication across teams lacked in structure and clear information given; but staff also self-reported lacking confidence in communicating key issues.
A quality improvement project with Plan-Do-Study-Act was adopted to design and implement a dedicated multidisciplinary safety briefing with a structured format.
The multidisciplinary safety briefing was to 90% of clinicians, and it took a median of 10 min to complete. Delayed referrals to the critical care outreach team were reduced by 46%. Positive changes included increased situational awareness and clearer communication across teams. Barriers identified were variable usage and need for face-to-face presence. Considering all the findings and the time constraint during the SARS-CoV-2 pandemic, we changed to a telephonic safety briefing directly to the team leaders.
A structured multidisciplinary safety briefing can improve patient safety and support management of deteriorating and acutely ill patients on the wards during the out-of-hours period.
安全简报有助于提高态势感知、促进跨专业沟通并改善患者安全。
一项临床调查显示，包括医疗团队和重症监护外展团队护士在内的90%的参与者认为，在非工作时间（20:00至08:00）召开的关于病情急剧恶化患者的会议气氛消极、不友好，存在贬低、敌意和无益的批评。参与者报告称，团队间沟通缺乏结构且信息传达不清晰；但工作人员也自我报告在沟通关键问题时缺乏信心。
采用计划-执行-研究-行动的质量改进项目，设计并实施了一个结构化的多学科安全简报。
90%的临床医生参加了多学科安全简报，完成简报的中位时间为10分钟。转诊至重症监护外展团队的延迟减少了46%。积极变化包括态势感知增强和团队间沟通更清晰。发现的障碍包括使用情况不一以及需要面对面交流。考虑到所有调查结果以及新冠疫情期间的时间限制，我们改为直接向团队负责人进行电话安全简报。
结构化的多学科安全简报可以提高患者安全，并支持在非工作时间对病房中病情恶化和急性病患者的管理。
