Nuernberger Matthias, Lang Sebastian, Maass Tabea, Lehmann Thomas, Brodoehl Stefan, Lewejohann Jan-Christoph
Department of Emergency Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
J Am Coll Emerg Physicians Open. 2025 Jan 9;6(1):100011. doi: 10.1016/j.acepjo.2024.100011. eCollection 2025 Feb.
Communication errors are the main cause of adverse events in emergency medicine, underscoring the importance of patient handover conversations. This study aims to assess the impact of implementing the ISOBAR handover protocol for patient transfer between emergency medical services and emergency department (ED) personnel.
We conducted a single-center implementation trial to evaluate the ISOBAR handover protocol efficacy in a German university hospital ED. We observed and analyzed 651 handover conversations involving adult patients, comparing those using the ISOBAR protocol to those following standard procedure without the protocol. Direct observation of handover processes was employed during alternating interventional periods across 6 trial phases. Primary outcome measure was the "Key Information Transfer Efficiency" score (KITE), a higher score indicating a more efficient patient handover conversation. Secondary outcome measure was the retention of key information by ED personnel, indicating successfully conveyed information.
The KITE score was significantly higher in the ISOBAR group (difference 0.12, 95% CI 0.02-0.22), showing a notable increase from baseline without ISOBAR to the final trial phase using ISOBAR (difference 0.16, 95% CI 0.02-0.34). Key information retention increased significantly: +18% for physicians (95% CI 9-28) and +19% (95% CI 10-28) for nurses. The number of questions asked after handover decreased by 29% (95% CI 5.81-41.46). The adherence to ISOBAR had no notable effect on outcome measures.
The implementation of ISOBAR can enhance information transfer during handover. However, adherence to ISOBAR was not crucial, highlighting the importance of focusing on quality of communication during patient handover.
沟通失误是急诊医学中不良事件的主要原因，这凸显了患者交接谈话的重要性。本研究旨在评估实施ISOBAR交接协议对急诊医疗服务与急诊科（ED）人员之间患者转运的影响。
我们在一家德国大学医院的急诊科进行了一项单中心实施试验，以评估ISOBAR交接协议的有效性。我们观察并分析了651次涉及成年患者的交接谈话，将使用ISOBAR协议的谈话与遵循无该协议的标准程序的谈话进行比较。在6个试验阶段的交替干预期内，采用直接观察交接过程的方法。主要结局指标是“关键信息传递效率”评分（KITE），分数越高表明患者交接谈话越高效。次要结局指标是急诊科人员对关键信息的留存情况，表明信息成功传递。
ISOBAR组的KITE评分显著更高（差值为0.12，95%置信区间为0.02 - 0.22），从无ISOBAR的基线水平到使用ISOBAR的最终试验阶段有显著增加（差值为0.16，95%置信区间为0.02 - 0.34）。关键信息留存率显著提高：医生提高了18%（95%置信区间为9 - 28），护士提高了19%（95%置信区间为10 - 28）。交接后提出的问题数量减少了29%（95%置信区间为5.81 - 41.46）。对ISOBAR的依从性对结局指标没有显著影响。
实施ISOBAR可增强交接过程中的信息传递。然而，对ISOBAR的依从性并非关键，这凸显了在患者交接过程中关注沟通质量的重要性。
