Identification of patient information corruption in the intensive care unit: Using a scoring tool to direct quality improvements in handover
Identification of patient information corruption in the intensive care unit: Using a scoring tool to direct quality improvements in handover
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DOI：
10.1097/ccm.0b013e3181a96267
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发表时间：
2009-11-01
影响因子：
8.8
通讯作者：
Marsh, Brian
中科院分区：
文献类型：
--
作者：
Pickering, Brian W.;Hurley, Killian;Marsh, Brian
目的：使用移交评估工具识别患者信息损坏并客观评估旨在减少移交错误和改善医疗决策的干预措施。在现代重症监护病房实践中，对患者的持续监测、干预和评估产生了大量信息，这些信息是做出医疗决策的平台。信息损坏，定义为与病历相比的失真/遗漏错误，可能导致医疗判断错误。识别这些错误可能会导致重症监护室护理交付和安全性的质量改进。设计：移交评估工具开发研究分为两个阶段，通过引入移交干预。设置：封闭，17张病床，大学附属混合外科/医疗重症监护室。受试者：重症监护室团队的高级和初级医疗成员。干预措施：测量和主要结果：研究对象被要求回忆临床信息通常讨论在移交个别病人。移交分数衡量的是每一次医患互动中正确保留信息的百分比。临床意向评分是医学判断的主观测量，由三位不知情的重症监护室专家进行评分（1-5）。共记录了137次互动。阶段1和阶段2的中位（四分位距）移交评分分别为79.07%（67.44-84.50）和83.72%（76.16-88.37）。移交干预降低了分数方差（p
Objective: To use a handover assessment tool for identifying patient information corruption and objectively evaluating interventions designed to reduce handover errors and improve medical decision making. The continuous monitoring, intervention, and evaluation of the patient in modern intensive care unit practice generates large quantities of information, the platform on which medical decisions are made. Information corruption, defined as errors of distortion/omission compared with the medical record, may result in medical judgment errors. Identifying these errors may lead to quality improvements in intensive care unit care delivery and safety.Design: Handover assessment instrument development study divided into two phases by the introduction of a handover intervention.Setting: Closed, 17-bed, university-affiliated mixed surgical/medical intensive care unit.Subjects: Senior and junior medical members of the intensive care unit team.Interventions: Electronic handover page.Measurements and Main Results: Study subjects were asked to recall clinical information commonly discussed at handover on individual patients. The handover score measured the percentage of information correctly retained for each individual doctor-patient interaction. The clinical intention score, a subjective measure of medical judgment, was graded (1-5) by three blinded intensive care unit experts. A total of 137 interactions were scored. Median (interquartile range) handover scores for phases 1 and 2 were 79.07% (67.44-84.50) and 83.72% (76.16-88.37), respectively. Score variance was reduced by the handover intervention (p