Jt Comm J Qual Patient Saf. 2024 Aug;50(8):560-568. doi: 10.1016/j.jcjq.2024.03.004. Epub 2024 Mar 8.
Communication failures are among the most common causes of harmful medical errors. At one Comprehensive Cancer Center, patient handoffs varied among services. The authors describe the implementation and results of an organization-wide project to improve handoffs and implement an evidence-based handoff tool across all inpatient services.
The research team created a task force composed of members from 22 hospital services-advanced practice providers (APPs), trainees, some faculty members, electronic health record (EHR) staff, education and training specialists, and nocturnal providers. Over two years, the task force expanded to include consulting services and Anesthesiology. Factors contributing to ineffective handoffs were identified and organized into categories. The EHR I-PASS tool was used to standardize handoff documentation. Training was provided to staff on its use, and compliance was monitored using a customized dashboard. I-PASS champions in each service were responsible for the rollout of I-PASS in their respective services. The data were reported quarterly to the Quality Assessment and Performance Improvement (QAPI) governing committee. Provider handoff perception was assessed through the biennial Institution-wide safety culture survey.
All fellows, residents, APPs, and physician assistants were trained in the use of I-PASS, either online or in person. Adherence to the I-PASS written tool improved from 41.6% in 2019 to 70.5% in 2022 (p < 0.05), with improvements seen in most services. The frequency of updating I-PASS elements and the action list in the handoff tool also increased over time. The handoff favorability score on the safety culture survey improved from 38% in 2018 to 59% in 2022.
The implementation approach developed by the Provider Handoff Task Force led to increased use of the I-PASS EHR tool and improved safety culture survey handoff favorability.
沟通失败是导致医疗伤害最常见的原因之一。在一家综合癌症中心，患者交接班在不同科室之间存在差异。作者描述了在全院范围内实施和实施改进交接班并在所有住院服务中实施基于证据的交接班工具的项目的情况。
研究团队成立了一个由来自 22 个医院科室的成员组成的特别工作组，包括高级实践提供者 (APP)、实习生、一些教员、电子健康记录 (EHR) 工作人员、教育和培训专家以及夜间提供者。在两年内，特别工作组扩大到包括咨询服务和麻醉科。确定了导致交接班无效的因素，并将其组织成不同的类别。使用 EHR I-PASS 工具来规范交接班记录。对工作人员进行了使用该工具的培训，并使用定制的仪表板来监测合规性。每个服务部门的 I-PASS 负责人负责在各自的服务部门中推出 I-PASS。数据每季度向质量评估和绩效改进 (QAPI) 管理委员会报告。通过两年一次的全院安全文化调查来评估提供者的交接班感知。
所有研究员、住院医师、APP 和医师助理都接受了 I-PASS 的使用培训，无论是在线培训还是现场培训。I-PASS 书面工具的依从性从 2019 年的 41.6%提高到 2022 年的 70.5%（p<0.05），大多数科室都有所提高。随着时间的推移，交接班工具中 I-PASS 元素和行动清单的更新频率也有所增加。安全文化调查中交接班的受欢迎程度评分从 2018 年的 38%提高到 2022 年的 59%。
由提供者交接班特别工作组制定的实施方法导致 EHR I-PASS 工具的使用增加，并提高了安全文化调查交接班的受欢迎程度。
