交接和转科护理：来自东部创伤外科学会的系统回顾、荟萃分析和实践管理指南。
Handoffs and transitions of care: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma.
机构信息
From the Division of Acute Care Surgery, Department of Surgery, Vanderbilt University Medical Center (R.D.A, S.G.), Nashville, Tennessee; University of Texas at Houston (T.J.P.); University of Nebraska Medical Center (Z.B.); Cleveland Clinic (S.A.); University of Arizona Health Sciences (A.S.); UT Southwestern Medical Center (R.P.D., D.B.); Texas Christian University (K.K., A.S.); Atrium Health Carolinas Medical Center (K.W.C.); Maine Medical Center (J.S.S.); Baylor Scott & White Health (C.R.H.); University of Cincinnati (M.S.); John Peter Smith Hospital (R.G.); and Baylor Scott & White All Saints Medical Center Fort Worth (J.F.).
出版信息
J Trauma Acute Care Surg. 2024 Aug 1;97(2):305-314. doi: 10.1097/TA.0000000000004285. Epub 2024 Feb 26.
BACKGROUND
The Joint Commission reports that at least half of communication breakdowns occur during handovers or transitions of care. There is no consensus on how best to approach the transfer of care within acute care surgery (ACS). We conduct a systematic review and meta-analysis of the current data on handoffs and transitions of care in ACS patients and evaluate the impact of standardization and formalized communication processes.
METHODS
Clinically relevant questions regarding handoffs and transitions of care with clearly defined patient Population(s), Intervention(s), Comparison(s), and appropriately selected Outcomes were determined. These centered around specific transitions of care within the setting of ACS, specifically perioperative interactions, emergency medical services and trauma team interactions, and intra/interfloor and intensive care unit (ICU) interactions. A systematic literature review and meta-analysis were conducted using the Grading of Recommendations Assessment, Development, and Evaluation methodology.
RESULTS
A total of 10 studies were identified for analysis. These included 5,113 patients in the standardized handoff group and 5,293 in the current process group. Standardized handoffs reduced handover errors for perioperative interactions and preventable adverse events for intra/interfloor and ICU interactions. There were insufficient data to evaluate outcomes of clinical complications and medical errors.
CONCLUSION
We conditionally recommend a standardized handoff in the field of ACS, including perioperative interactions, emergency medical services and trauma team interactions, and intra/interfloor and ICU interactions.
LEVEL OF EVIDENCE
Systematic Review/Meta-analysis; Level III.
背景
联合委员会报告称，至少有一半的沟通失误发生在交接或护理过渡期间。目前对于如何在急性护理外科（ACS）中进行护理交接还没有达成共识。我们对 ACS 患者交接和护理过渡的现有数据进行了系统回顾和荟萃分析，并评估了标准化和正式沟通流程的影响。
方法
确定了与交接和护理过渡相关的临床相关问题，这些问题具有明确界定的患者人群、干预措施、比较和适当选择的结果。这些问题集中在 ACS 环境中的特定护理过渡，具体包括围手术期交互、紧急医疗服务和创伤小组交互以及内部/楼层间和重症监护病房（ICU）交互。使用 Grading of Recommendations Assessment, Development, and Evaluation 方法进行了系统的文献回顾和荟萃分析。
结果
共确定了 10 项研究进行分析。这些研究包括标准化交接组的 5113 名患者和当前流程组的 5293 名患者。标准化交接减少了围手术期交互中的交接错误，并预防了内部/楼层间和 ICU 交互中的可预防不良事件。没有足够的数据来评估临床并发症和医疗错误的结果。
结论
我们有条件地推荐在 ACS 领域采用标准化交接，包括围手术期交互、紧急医疗服务和创伤小组交互以及内部/楼层间和 ICU 交互。
证据水平
系统评价/荟萃分析；III 级。
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