Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
University of Kansas School of Medicine, Wichita, KS.
Am J Med Qual. 2024;39(5):229-243. doi: 10.1097/JMQ.0000000000000204. Epub 2024 Sep 16.
Handoffs involve the transfer of patient information and responsibility for care between health care professionals. The purpose of the current scoping review was (1) to describe handoff studies with education as part of the intervention and (2) to explore the role of handoff educational interventions in sustaining handoff improvements. This scoping review utilized previously published systematic reviews and a structured, systematic search of 5 databases (January 2006-June 2020). Articles were identified, and data were extracted by pairs of trained, independent reviewers. The search identified 74 relevant articles, most published after 2015 (70%) and conducted in the United States (76%). Almost all of the studies (99%) utilized instruction, 66% utilized skills practice, 89% utilized a memory aid, and 43% utilized reinforcement. However, few studies reported using education theory or followed accepted tenets of curriculum development. There has been a substantial increase over time in reporting actual handoff behavior change (17%-68%) and a smaller but important increase in reporting patient outcomes (11%-18%). Thirty-five percent of studies (26/74) had follow-up for 6 months or more. Twelve studies met the criteria for sustained change, which were follow-up for 6 months or more and achieving statistically significant improvements in either handoff skills/processes or patient outcomes at the conclusion of the study. All 12 studies with sustained change used multi-modal educational interventions, and reinforcement was more likely to be used in these studies than all others (75%, 9/12) versus (37%, 23/62), P = 0.015. Future handoff intervention efforts that include education should use education theory to guide development and include needs assessment and goals and measurable objectives. Educational interventions should be multi-modal and include reinforcement. Future research studies should measure actual handoff behavior change (skills/process) and patient outcomes, include follow-up for more than 6 months, and use education reporting guidelines.
交接班涉及医疗保健专业人员之间的患者信息和护理责任的转移。本范围综述的目的是：(1) 描述作为干预措施一部分包含教育的交接班研究；(2) 探索交接班教育干预措施在维持交接班改进方面的作用。本范围综述利用了已发表的系统综述和对 5 个数据库(2006 年 1 月至 2020 年 6 月)的结构化、系统搜索。由两名经过培训的独立审查员对文章进行了识别和数据提取。搜索确定了 74 篇相关文章，其中大多数发表于 2015 年以后(70%)，且在美国进行(76%)。几乎所有的研究(99%)都利用了教学，66%利用了技能实践，89%利用了记忆辅助，43%利用了强化。然而，很少有研究报告使用教育理论或遵循课程开发的公认原则。随着时间的推移，实际交接班行为改变的报告有了实质性的增加(17%-68%)，而患者结果报告的增加虽然较小，但也很重要(11%-18%)。35%(26/74)的研究有 6 个月或更长时间的随访。12 项研究符合持续变化的标准，即随访 6 个月或更长时间，并且在研究结束时在手交接班技能/流程或患者结果方面取得了统计学上的显著改善。所有 12 项具有持续变化的研究都使用了多模式教育干预措施，并且在这些研究中强化的使用比其他研究更常见(75%，9/12)与(37%，23/62)，P=0.015。包含教育的未来交接班干预措施应使用教育理论来指导其发展，并包括需求评估、目标和可衡量的目标。教育干预措施应该是多模式的，包括强化。未来的研究应该测量实际的交接班行为改变(技能/流程)和患者结果，包括超过 6 个月的随访，并使用教育报告指南。
