Reilly Devin, Shandilya Shaefali, Streater Blair, Aprile Bettina, Aprile Justen M
Pediatrics, Penn State Health Children's Hospital, Hershey, USA.
Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2024 Feb 1;16(2):e53413. doi: 10.7759/cureus.53413. eCollection 2024 Feb.
Background Handoffs serve a critical patient safety function in the transition between caregivers. In 2006, the Joint Commission on Accreditation of Healthcare Organizations strongly recommended the implementation of "a standardized approach to 'handoff' communications, including an opportunity to ask and respond to questions." Numerous studies have investigated the quality and efficacy of patient handoffs and the utility of structured handoff curriculums, particularly in the context of patient safety and outcomes. Objective The pediatric residents at Penn State Health (PSH) did not utilize a formal written or verbal handoff tool. Our study facilitated the design of a comprehensive handoff curriculum, including verbal and written components, and the implementation of faculty and multidisciplinary care team involvement coupled with resident training and observations. We investigate the impact of this curriculum longitudinally utilizing validated tools completed by external observers as well as the residents themselves. Methods Prior to SAFETIPS being implemented, residents at a mid-sized Pediatric program were observed giving handovers at various intervals to understand baseline habits. Residents were then educated with the SAFETIPS curriculum and again observed. Trained observers of the handover process completed a validated evaluation form concentrating on seven key domains necessary for effective handover and communication; residents involved in the handover also completed a validated evaluation form. Consent for the project was implied with the observer's presence during the process and our study was exempt from full IRB consideration given its quality improvement design. A mix of summary statistics, stacked dot plots, mixed effects regression, and joint F tests were used to analyze data. Results Mean values on all sections of the handover evaluation Likert scale completed by trained observers tended to increase over time; the variance in responses was likewise much smaller at later time periods. Similarly, all sections of the evaluation tools completed by the resident physicians themselves showed significantly increased scores from pre- to post-implementation of our curriculum. Data revealed a plateauing of results toward later time points suggestive of skills mastery and sustained improvements. Conclusion Our findings suggest that the introduction of a structured handoff curriculum correlated with improved communication among residents, and such improvements were sustained over time.
交接班在医护人员交接过程中对患者安全起着至关重要的作用。2006年，医疗组织认证联合委员会强烈建议实施“标准化的‘交接班’沟通方法，包括提问和回答问题的机会”。许多研究调查了患者交接班的质量和效果以及结构化交接班课程的效用，特别是在患者安全和结果方面。目的：宾夕法尼亚州立大学健康医疗中心（PSH）的儿科住院医师未使用正式的书面或口头交接班工具。我们的研究推动了一个全面交接班课程的设计，包括口头和书面部分，并实施了教师和多学科护理团队的参与以及住院医师培训和观察。我们纵向调查该课程的影响，使用外部观察员以及住院医师自己完成的经过验证的工具。方法：在实施SAFETIPS之前，观察一个中型儿科项目的住院医师在不同时间间隔进行的交接班，以了解基线习惯。然后让住院医师接受SAFETIPS课程培训并再次进行观察。经过培训的交接班过程观察员完成一份经过验证的评估表，重点关注有效交接班和沟通所需的七个关键领域；参与交接班的住院医师也完成一份经过验证的评估表。由于观察员在过程中的在场意味着对该项目的同意，并且鉴于我们研究的质量改进设计，该研究无需经过机构审查委员会（IRB）的全面审议。使用汇总统计、堆叠点图、混合效应回归和联合F检验来分析数据。结果：由经过培训的观察员完成的交接班评估李克特量表所有部分的平均值随时间趋于增加；后期回答的方差同样小得多。同样地，住院医师自己完成的评估工具所有部分显示，从我们课程实施前到实施后分数显著提高。数据显示后期时间点的结果趋于平稳，表明技能掌握和持续改进。结论：我们的研究结果表明，引入结构化交接班课程与住院医师之间沟通的改善相关，并且这种改善随着时间的推移得以持续。
