What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff.
What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff.
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DOI：
10.1136/qshc.2008.028654
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发表时间：
2009-08
影响因子：
--
通讯作者：
Bradley EH
中科院分区：
文献类型：
--
作者：
Horwitz LI;Moin T;Krumholz HM;Wang L;Bradley EH
描述和评估内科药房工作人员的签出实践，并确定影响签出质量的因素。前瞻性录音带研究急性教学医院的内科病房8个内科病房的工作人员团队的定量和定性评估的签出内容，清晰的语言，环境，影响质量和全面性的口头签出的因素。退出会话（N=88）包含503例患者退出。我们收集了50/88次退出会议（57%）的完整书面退出。每例患者退出的中位持续时间为35秒（IQR 19-62）。184/298（62%）例患者的口头和书面签名描述了临床状况、住院过程以及是否需要完成任务。最不常传达的是患者当前的临床状况，在249/503（50%）的口头退出和117/306（38%）的书面退出中进行了描述。大多数患者退出（298/503，59%）不包括退出接收者提出的问题（中位数0，IQR 0-1）。五个因素与较高的口头内容包括率：熟悉病人，对病人的责任感，每天只有一个签出，存在的高级居民，和全面的书面签出。数据的遗漏和错误描述存在于22%的在一天内重复的注销中。注销并不统一全面，包括几个问题。我们的研究结果表明，可能需要几个变化，以提高签出质量，包括标准化的关键内容，尽量减少不涉及主要团队的签出，模板化的书面签出，强调签出在维护患者安全的作用，并培养直接责任感的覆盖员工之间的患者。
To characterize and assess sign-out practices among internal medicine house staff, and to identify contributing factors to sign-out quality. Prospective audiotape study Medical wards of an acute teaching hospital Eight internal medicine house staff teams Quantitative and qualitative assessments of sign-out content, clarity of language, environment, and factors affecting quality and comprehensiveness of oral sign-out. Sign-out sessions (N=88) contained 503 patient sign-outs. We collected complete written sign-outs accompanying 50/88 sign-out sessions (57%). Median duration of sign-out was 35 seconds (IQR 19–62) per patient. The combined oral and written sign-outs described clinical condition, hospital course and whether or not there was a task to be completed for 184/298 (62%) of patients. Least commonly conveyed was patient’s current clinical condition, described in 249/503 (50%) of oral sign-outs and 117/306 (38%) of written sign-outs. Most patient sign-outs (298/503, 59%) included no questions from the sign-out recipient (median 0, IQR 0–1). Five factors were associated with a higher rate of oral content inclusion: familiarity with the patient, sense of responsibility for the patient, only one sign-out per day, presence of a senior resident, and a comprehensive written sign-out. Omissions and mischaracterizations of data were present in 22% of sign-outs repeated in a single day. Sign-outs are not uniformly comprehensive and include few questions. Our findings suggest that several changes may be required to improve sign-out quality, including standardizing key content, minimizing sign-outs that do not involve the primary team, templating written sign-outs, emphasizing the role of sign-out in maintaining patient safety, and fostering a sense of direct responsibility for patients among covering staff.
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影响因子：
5.7
作者：
Horwitz, Leora I.;Moin, Tannaz;Green, Michael L.
通讯作者：
Green, Michael L.
影响因子：
2.5
作者：
Eisenberg, EM;Murphy, AG;Vanderhoef, M
通讯作者：
Vanderhoef, M
影响因子：
--
作者：
Lingard, L;Espin, S;Grober, E
通讯作者：
Grober, E
影响因子：
5.9
作者：
Arora, Vineet M.;Farnan, Jeanne M.
通讯作者：
Farnan, Jeanne M.
影响因子：
--
作者：
Horwitz, Leora I.;Moin, Tannaz;Bradley, Elizabeth H.
通讯作者：
Bradley, Elizabeth H.