A Prospective Observational Study of Physician Handoff for Intensive-Care-Unit-to-Ward Patient Transfers
A Prospective Observational Study of Physician Handoff for Intensive-Care-Unit-to-Ward Patient Transfers
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DOI：
10.1016/j.amjmed.2011.04.027
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发表时间：
2011-09-01
影响因子：
5.9
通讯作者：
Ghali, William Amin
中科院分区：
文献类型：
--
作者：
Li, Pin;Stelfox, Henry Thomas;Ghali, William Amin
背景：糟糕的医生交接可能是医院发生不理想护理和医疗差错的主要原因。重症监护室（ICU）到病房的病人转移的医生交接可能面临更多的沟通障碍。然而，很少有研究关注病人从ICU转移到住院病房的医生交接。方法：我们在一个城市大学附属三级护理中心进行了一项住院患者为基础的观察性研究，以评估icu到病房患者转移的医生交接实践。纳入了112名成年患者。访谈了利益相关者（派遣医生、接收医生和患者/家属），以评估这些转移过程中的沟通质量。收集的数据包括沟通的存在和有效性、护理的连续性和总体满意度。结果：患者转院初期，15.6%的会诊接诊医师与送诊医师有口头沟通；26%的接诊医生在病人转院时收到了来自接诊医生的口头沟通。患者转移过程中沟通不畅导致13起医疗差错，2名患者暂时“失去”医疗护理。总体而言，派遣医生、接收医生和患者的沟通满意度（以10分制评分）分别为7.9 +/- 1.1、8.1 +/- 1.0和7.9 +/- 1.7。结论：利益相关者对icu转病房过程中沟通的总体满意度较高。然而，改善医生沟通质量的明显机会存在于几个领域，对护理质量和患者安全有潜在的好处。(C) 2011爱思唯尔公司版权所有。美国医学杂志（2011）124,860-867
BACKGROUND: Poor physician handoff can be a major contributor to suboptimal care and medical errors occurring in the hospital. Physician handoffs for intensive care unit (ICU)-to-ward patient transfer may face more communication hurdles. However, few studies have focused on physician handoffs in patient transfers from the ICU to the inpatient ward.METHODS: We performed a hospitalized patient-based observational study in an urban, university-affiliated tertiary care center to assess physician handoff practices for ICU-to-ward patient transfer. One hundred twelve adult patients were enrolled. The stakeholders (sending physicians, receiving physicians, and patients/families) were interviewed to evaluate the quality of communication during these transfers. Data collected included the presence and effectiveness of communication, continuity of care, and overall satisfaction.RESULTS: During the initial stage of patient transfers, 15.6% of the consulted receiving physicians verbally communicated with sending physicians; 26% of receiving physicians received verbal communication from sending physicians when patient transfers occurred. Poor communication during patient transfer resulted in 13 medical errors and 2 patients being transiently "lost" to medical care. Overall, the levels of satisfaction with communication (scored on a 10-point scale) for sending physicians, receiving physicians, and patients were 7.9 +/- 1.1, 8.1 +/- 1.0, and 7.9 +/- 1.7, respectively.CONCLUSION: The overall levels of satisfaction with communication during ICU-to-ward patient transfer were reasonably high among the stakeholders. However, clear opportunities to improve the quality of physician communication exist in several areas, with potential benefits to quality of care and patient safety. (C) 2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 860-867