Inefficiencies and vulnerabilities of telephone-based communication between U. S. poison control centers and emergency departments
Inefficiencies and vulnerabilities of telephone-based communication between U. S. poison control centers and emergency departments
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DOI：
10.3109/15563650.2013.801981
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发表时间：
2013-06-01
影响因子：
3.3
通讯作者：
Repko, Katherine
中科院分区：
文献类型：
--
作者：
Cummins, Mollie R.;Crouch, Barbara;Repko, Katherine
上下文。毒物控制中心(PCCs)和急诊科(EDs)依靠电话通信进行协作。在协作过程中，PCC和急诊医生各自为同一患者创建电子记录，但不共享这些电子记录。目标。这项研究的目的是描述目前基于电话的PCC-ED通信流程，作为潜在流程改进的基础。材料和方法。这项研究是在一家PCC和两家三级护理急诊室进行的。我们开发了工作流程图来描述临床医生对当前过程的描述，这些描述是通过采访关键信息者获得的。我们还分析了急诊科和毒物控制中心之间的电话记录，对应于2011年1月1日至12月31日发生的120例PCC病例的随机抽样。结果。ED和PCC之间的协作发生在多个电话呼叫期间，而共享文档不支持这一过程。这一过程分三个阶段进行：通知、协作护理和持续咨询。在急诊室，多个护理提供者可以与PCC通信，但一次只有一个急诊护理人员与毒物控制中心专家通信。ED和PCC都会发生切换。协作性护理计划很常见，大多数病例涉及某种类型的信息请求，无论是生命体征、实验室结果，还是对实施治疗的验证。我们发现了效率低下和安全漏洞的证据，包括PCC专家无法联系到急诊护理提供者，电话呼叫通过多名急诊工作人员转接试图联系到适当的护理提供者，以及与非临床工作人员交换临床信息。在55%的病例中，患者在急诊护理提供者和PCC专家之间进行任何同步电话通信之前就出院了。22%的病例观察到信息交流不明确。在12%的个案中，公众投诉专科医生无法从教育署取得所要求的资料。讨论和结论。在基于电话的PCC-ED通信中会出现效率低下和漏洞。谨慎要求考虑ED-PCC沟通和信息共享的替代流程和模式，包括支持与卫生信息交换协作的流程。
Context. Poison control centers (PCCs) and emergency departments (EDs) rely upon telephone communication to collaborate. PCCs and EDs each create electronic records for the same patient during the course of collaboration, but those electronic records are not shared. Objective. The purpose of this study was to describe the current, telephone based process of PCC-ED communication as the basis for potential process improvement. Materials and methods. This study was conducted at one PCC and two tertiary care EDs. We developed workflow diagrams to depict clinician descriptions of the current process, descriptions obtained through interviews of key informants. We also analyzed transcripts of phone calls between emergency departments and the poison control center, corresponding to a random sample of 120 PCC cases occurring January 1-December 31, 2011. Results. Collaboration between the ED and PCC takes place during multiple telephone calls, and the process is unsupported by shared documentation. The process occurs in three phases: notification, collaborative care, and ongoing consultation. In the ED, multiple care providers may communicate with the PCC, but only one ED care provider communicates with the poison control center specialist at a time. Handoffs occur for both ED and PCC. Collaborative care planning is common and most cases involve some type of request for information, whether vital signs, laboratory results, or verification that a treatment was administered. We found evidence of inefficiencies and safety vulnerabilities, including the inability of PCC specialists to reach ED care providers, telephone calls routed through multiple ED staff members in an attempt to reach the appropriate care provider, and exchange of clinical information with non-clinical staff. In 55% of cases, the patient was discharged prior to any synchronous telephone communication between the ED care provider and a PCC specialist. Ambiguous communication of information was observed in 22% of cases. In 12% of cases, a PCC specialist was unable to obtain requested information from the ED. Discussion and conclusion. Inefficiencies and vulnerabilities occur in telephone-based PCC-ED communication. Prudence begs consideration of alternative processes and models of ED-PCC communication and information sharing, including a process that supports collaboration with health information exchange.