Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland.
University College Cork, College Road, Cork, Ireland.
Ir J Med Sci. 2024 Jun;193(3):1125-1129. doi: 10.1007/s11845-023-03585-2. Epub 2023 Dec 8.
Clinical handover is an essential step in the surgical patient's hospital journey, but one that is not without risk. Within cardiothoracic surgery, endeavours to protocolise post-operative handover from cardiac theatre to cardiac intensive care units have resulted in enhanced patient safety, but little to no effort has focused on the pre-operative setting and the dissemination of information throughout the surgical team.
We designed a pre-post study examining the quality of pre-operative cardiothoracic patient handovers before and after the introduction of an intra-departmentally designed "Cardiothoracic Clinical Handover Tool" based on the Royal College of Surgeons of England's guidelines for "Safe Handover".
Forty clinical handovers were assessed in each arm of the study. Handover quality improved from a score of 63.75% to 88.57% (p = < 0.001). This prolonged handover duration from a mean of 72.1 to 102.4 seconds per case (p = 0.003). Interruptions occurred in 27.5% of pre- and 25% of post-intervention handovers. Interruptions resulted in increased handover duration in both pre- and post-intervention groups (114.6 vs 77.7 seconds, p = 0.012) and poorer quality handovers in the pre-intervention group (51.28% vs 68.42%, p = 0.03) but failed to impact handover quality in the post-intervention group (88.57% vs 88.57%, p = 1).
Clinical handover tools have the potential to enhance the quality of pre-operative handover and protect against poor handover practices such as interruptions, safe-guarding patient welfare. We provide the first cardiothoracic specific pre-operative handover tool based on the RCSE guidelines.
临床交接是外科患者住院过程中的一个重要步骤，但并非没有风险。在心胸外科，努力将术后交接从心脏手术室规范到心脏重症监护病房，已经提高了患者的安全性，但几乎没有关注术前环境和手术团队信息的传播。
我们设计了一项前后研究，在引入基于英国皇家外科学院“安全交接”指南的部门内设计的“心胸外科临床交接工具”前后，检查了术前心胸外科患者交接的质量。
研究的每个臂都评估了 40 次临床交接。交接质量从 63.75%提高到 88.57%（p < 0.001）。交接持续时间从每个病例的平均 72.1 秒延长到 102.4 秒（p = 0.003）。在干预前交接中有 27.5%发生了中断，在干预后交接中有 25%发生了中断。在干预前和干预后组中，中断都会导致交接时间延长（114.6 秒比 77.7 秒，p = 0.012），并且在干预前组中交接质量更差（51.28%比 68.42%，p = 0.03），但未能影响干预后组的交接质量（88.57%比 88.57%，p = 1）。
临床交接工具有可能提高术前交接的质量，并防止中断等不良交接做法，保障患者的福利。我们提供了第一个基于 RCSE 指南的心胸外科特定的术前交接工具。
