Results of an Enhanced Clinic Handoff and Resident Education on Resident Patient Ownership and Patient Safety
Results of an Enhanced Clinic Handoff and Resident Education on Resident Patient Ownership and Patient Safety
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DOI：
10.1097/acm.0b013e31828fd3c4
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发表时间：
2013-06-01
影响因子：
7.4
通讯作者：
Arora, Vineet M.
中科院分区：
文献类型：
--
作者：
Pincavage, Amber T.;Dahlstrom, Marcus;Arora, Vineet M.
目的 尽管内科住院医师诊所交接会给患者带来风险，但几乎没有干预措施。作者评估了增强的交接。方法 2011 年，作者正式制定了交接协议，包括标准化的签出流程、住院医师教育、改进的日程安排以及通过电话访问建立护理的时间。作者在 2011 年和 2010 年调查了 25 名居民和 2010 年的 19 名居民，了解他们的看法，并进行图表审核以检查患者的治疗结果。 结果 与 2010 年相比，2011 年的居民报告交接时间更长（> 20 分钟，52% 对比 6%，P < .01），更多的口头交接（80% 对比 38%，P < .01），更多患者意识到交接（100% 与 74%，P = .01），尚未就诊的患者对文书工作的不适感较少（40% 与 74%，P = .03），并且在首次就诊之前对患者有更多的主人翁意识（56% 与 26%，P = .05）。 2011 年，更多的患者去看了正确的初级保健提供者（82% 对 44%，P < .01），并且更多的检查得到了适当的随访（67% 对 46%，P = .02）。作者在 2011 年发现，患者在医生预定的月份就诊的趋势（40% 对比 33%，P = 0.06）以及交接后三个月急症（医院和急诊科）就诊次数减少的趋势（20% 对比 26%，P = 0.06）。 结论 加强诊所交接可以改善交接过程，增加患者在目标时间范围内去看正确的初级保健提供者的可能性，减少错过的检查，并可能减少急症的发生。访问。
Purpose Although internal medicine resident clinic handoffs present risks for patients, few interventions exist. The authors evaluated an enhanced handoff.Method In 2011, the authors formalized a handoff protocol including a standardized sign-out process, resident education, improved scheduling, and time to establish care through telephone visits. The authors surveyed 25 residents in 2011 and 19 in 2010 regarding their perceptions and performed chart audits to examine patient outcomes.Results Compared with 2010, residents in 2011 reported longer handoffs (>20 minutes, 52% versus 6%, P < .01), more verbal handoffs (80% versus 38%, P < .01), more patients aware of the handoff (100% versus 74%, P = .01), less discomfort with paperwork for patients not yet seen (40% versus 74%, P = .03), and more ownership of patients before the first visit (56% versus 26%, P = .05). In 2011, more patients saw their correct primary care provider (82% versus 44%, P < .01), and more tests were followed up appropriately (67% versus 46%, P = .02). The authors detected in 2011 a trend for patients to be seen the month their physician intended (40% versus 33%, P =.06) and a trend toward fewer acute (hospital and emergency department) visits three months post handoff (20% versus 26%, P = .06).Conclusions Enhancing clinic handoffs can improve the handoff process, increase the likelihood of patients seeing the correct primary care provider within the target time frame, reduce missed tests, and possibly reduce acute visits.