Monard Céline, Carrere Josselin, Abraham Paul, Cerro Valerie, Polazzi Stephanie, Payet Cécile, Rimmelé Thomas, Duclos Antoine
Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
PI3 (Pathophysiology of Injury-Induced Immunosuppression), Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Biomérieux, Lyon, EA, 7426, France.
BMC Health Serv Res. 2024 Dec 4;24(1):1544. doi: 10.1186/s12913-024-12007-7.
Handoffs are a major determinant of patient's safety but their implementation remains heterogeneous and non-standardized. Organizational factors, including the order in which individual cases are handled within the handoff, may play a role in their quality. We aimed to confirm the existence of the portfolio effect (e.g. a decrease in duration allocated to individual cases as the global handoff progresses) in ICU's morning medical handoffs.
Two research assistants observed the morning handoffs in two ICUs (ICU-1, a 20-bed trauma and surgical ICU and ICU-2 a 10-bed medical and surgical ICU) within a university hospital, over a 6-month period. They were trained to measure the duration of each case (i.e., the handoff of a single patient). Patients' socio-demographic and clinical data were extracted from electronic medical records. The effect of the case position within the global handoff on its duration was determined using a linear regression after log transformation of duration. The case position was categorized as either before or after the median position (first and second halves). Covariates clinically associated with handoff duration were included in the model (age, sex, Charlson comorbidities index, SAPS II score, number of organ supports, center (ICU-1 or ICU-2) and reason for admission).
2485 individual cases nested in 169 morning handoffs and related to 494 patients' stays were observed. The mean (± SD) duration of the morning handoff was 60 minutes (± 12.5) in ICU-1 and 35.2 minutes (± 10.6) in ICU-2 with a mean number of cases presented of 18.9 (± 1.3) and 9.3 (± 1.0) respectively. The mean (± SD) duration of a case was 175 seconds (± 108). Trauma stays, patients severity and comorbidities, and the number of organ supports were associated with longer case handoffs. Asjusting for these covariates, cases in the second half were shorter compared to cases in the first half (RR 0.65, 95%CI (0.51 - 0.80)).
We confirmed the existence of a portfolio effect within ICU handoffs, emphasizing that interventions targeting handoffs' improvement should focus on the content and the setting. We suggest avoiding the presentation of a same patient systematically at the end of the round.
交接班是患者安全的主要决定因素，但其实施仍存在异质性且未标准化。组织因素，包括在交接班过程中处理各个病例的顺序，可能会影响其质量。我们旨在证实重症监护病房（ICU）晨间医疗交接班中是否存在组合效应（例如，随着整体交接班的进行，分配给单个病例的时间减少）。
两名研究助理在一所大学医院的两个ICU（ICU-1，一个有20张床位的创伤和外科ICU；ICU-2，一个有10张床位的内科和外科ICU）观察了为期6个月的晨间交接班。他们接受培训以测量每个病例（即单个患者的交接班）的时长。患者的社会人口统计学和临床数据从电子病历中提取。在对时长进行对数转换后，使用线性回归确定病例在整体交接班中的位置对其时长的影响。病例位置被分类为中位数位置之前或之后（前半部分和后半部分）。模型中纳入了与交接班时长临床相关的协变量（年龄、性别、查尔森合并症指数、简化急性生理学评分II、器官支持数量、中心（ICU-1或ICU-2）和入院原因）。
观察到嵌套在169次晨间交接班中的2485个个体病例，涉及494名患者的住院情况。ICU-1晨间交接班的平均（±标准差）时长为60分钟（±12.5），ICU-2为35.2分钟（±10.6），平均报告病例数分别为18.9（±1.3）和9.3（±1.0）。一个病例的平均（±标准差）时长为175秒（±108）。创伤住院、患者的严重程度和合并症以及器官支持数量与更长的病例交接班时间相关。在对这些协变量进行调整后，后半部分的病例比前半部分的病例短（风险比0.65，95%置信区间（0.51 - 0.80））。
我们证实在ICU交接班中存在组合效应，强调针对改善交接班的干预措施应侧重于内容和环境。我们建议避免在查房结束时系统性地展示同一患者。
