Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality
Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality
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DOI：
10.1111/j.1460-9592.2006.02239.x
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发表时间：
2007-05-01
影响因子：
1.7
通讯作者：
Goldman, Allan J.
中科院分区：
文献类型：
--
作者：
Catchpole, Ken R.;De Leval, Marc R.;Goldman, Allan J.
背景资料：我们的目的是提高质量和安全移交的病人从手术到重症监护使用类比的一级方程式赛车进站和专业知识从aviation.Methods：一项前瞻性干预研究测量的性能变化之前和之后实施的一个新的移交协议，是通过详细的讨论与一级方程式赛车队和航空训练队长。观察了50例（术前23例，术后27例）术后患者。使用清单衡量技术错误和信息遗漏，并使用李克特量表对团队合作进行评分。还测量了移交的持续时间。技术错误的平均数量从5.42减少到（95% CI +/- 1.24）至3.15（95% CI +/- 0.71），信息移交遗漏的平均数量从2.09减少到（95% CI +/- 1.14）降至1.07（95% CI +/- 0.55），移交持续时间从10.8 min（95% CI +/- 1.6）降至9.4 min（95% CI +/- 1.29）。在新方案实施前，23名预处理患者中有9名（39%）在技术和信息移交方面存在一个以上的错误，而在新方案实施后，27名预处理患者中有3名（11.5%）存在错误。回归分析显示，新的交接协议显著减少了技术错误的数量（t =-3.63，P < 0.001），交互作用表明团队合作（t = 3.04，P = 0.004）对新的交接协议有不同的影响。其他行业的专业知识可以用来提高患者安全性，特别是涉及患者或信息移交的医学领域。
Background: We aimed to improve the quality and safety of handover of patients from surgery to intensive care using the analogy of a Formula I pit stop and expertise from aviation.Methods: A prospective intervention study measured the change in performance before and after the implementation of a new handover protocol that was developed through detailed discussions with a Formula 1 racing team and aviation training captains. Fifty (23 before and 27 after) postsurgery patient handovers were observed. Technical errors and information omissions were measured using checklists, and teamwork was scored using a Likert scale. Duration of the handover was also measured.Results: The mean number of technical errors was reduced from 5.42 (95% CI +/- 1.24) to 3.15 (95% CI +/- 0.71), the mean number of information handover omissions was reduced from 2.09 (95% CI +/- 1.14) to 1.07 (95% CI +/- 0.55), and duration of handover was reduced from 10.8 min (95% CI +/- 1.6) to 9.4 min (95% CI +/- 1.29). Nine out of twenty-three (39%) precondition patients had more than one error in both technical and information handover prior to the new protocol, compared with three out of twenty-seven (11.5%) with the new handover. Regression analysis showed that the number of technical errors were significantly reduced with the new handover (t = -3.63, P < 0.001), and an interaction suggested that teamwork (t = 3.04, P = 0.004) had a different effect with the new handover protocol.Conclusions: The introduction of the new handover protocol lead to improvements in all aspects of the handover. Expertise from other industries can be extrapolated to improve patient safety, and in particular, areas of medicine involving the handover of patients or information.