From the Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA (Dr. Lightsey); the Rothman Orthopaedic Institute/Thomas Jefferson University Spine Fellowship Program, Philadelphia, PA (Dr. Yeung); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Rossi, Dr. Harris, and Dr. Stenquist); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr. Chen).
J Am Acad Orthop Surg Glob Res Rev. 2023 Nov 27;7(12). doi: 10.5435/JAAOSGlobal-D-23-00208. eCollection 2023 Dec 1.
Standardized handoff tools improve communication and patient care; however, their widespread use in surgical fields is lacking. OrthoPass, an orthopaedic adaptation of I-PASS, was developed in 2019 to address handoff concerns and demonstrated sustained improvements across multiple handoff domains over an 18-month period. We sought to characterize the longitudinal effect and sustainability of OrthoPass within a single large residency program 3.5 years after its implementation. This mixed methods study involved electronic handoff review for quality domains in addition to survey distribution and evaluation. We conducted comparative analyses of handoff adherence and survey questions as well as a thematic analysis of provider-free responses. We evaluated 146 electronic handoffs orthopaedic residents, fellows, and advanced practice providers 3.5 years after OrthoPass implementation. Compared with 18-month levels, adherence was sustained across five of nine handoff domains and was markedly improved in two domains. Furthermore, provider valuations of OrthoPass improved regarding promoting communication and patient safety (83% versus 70%) and avoiding patient errors and near misses (72% versus 60%). These improvements were further substantiated by positive trends in Agency for Healthcare Research and Quality Surveys on Patient Safety Culture hospital survey data. Thematic analysis of free responses shared by 37 providers (42%) generated favorable, unfavorable, and balanced themes further contextualized by subthemes. At 3.5 years after its introduction, OrthoPass continues to improve patient handoff quality and to support provider notions of patient safety. Although providers acknowledged the benefits of this electronic handoff tool, they also shared unique insights into several drawbacks. This feedback will inform ongoing efforts to improve OrthoPass.
标准化交接班工具可改善沟通和患者护理；然而，它们在外科领域的广泛应用仍存在不足。OrthoPass 是 I-PASS 的骨科改良版，于 2019 年开发，旨在解决交接班问题，并在 18 个月的时间内持续改善多个交接班领域。我们旨在描述 OrthoPass 在实施 3.5 年后在单个大型住院医师培训计划中的长期效果和可持续性。这项混合方法研究包括电子交接班质量评估，以及问卷调查和评估。我们对交接班的遵守情况和调查问题进行了对比分析，并对提供者的自由回复进行了主题分析。我们评估了 OrthoPass 实施 3.5 年后的 146 名骨科住院医师、研究员和高级执业医师的 146 次电子交接班。与 18 个月时相比，9 个交接班领域中的 5 个领域的遵守率保持稳定，2 个领域的遵守率显著提高。此外，提供者对 OrthoPass 的评价在促进沟通和患者安全（83%比 70%）以及避免患者错误和险些发生的差错（72%比 60%）方面有所提高。医疗机构中患者安全文化医院调查数据的美国医疗保健研究和质量机构调查的积极趋势进一步证实了这些改进。对 37 名（42%）提供者分享的自由回复进行的主题分析生成了有利、不利和平衡的主题，并进一步通过子主题进行了背景化。在引入 3.5 年后，OrthoPass 继续提高患者交接班质量，并支持提供者对患者安全的看法。尽管提供者承认这种电子交接班工具的好处，但他们也分享了对几个缺点的独特见解。这些反馈将为改进 OrthoPass 提供信息。
