Consequences of inadequate sign-out for patient care
Consequences of inadequate sign-out for patient care
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DOI：
10.1001/archinte.168.16.1755
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发表时间：
2008-09-08
影响因子：
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通讯作者：
Bradley, Elizabeth H.
中科院分区：
文献类型：
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作者：
Horwitz, Leora I.;Moin, Tannaz;Bradley, Elizabeth H.
背景：在病例报告中，医疗保健提供者之间的患者护理转移与不良事件有关。然而，鲜为人知的是，这些转让相关的problems.Methods的性质和频率：我们进行了一项前瞻性的录音带研究12天的“签出”的临床信息之间的8个内科医院的工作人员团队。每天，要求后召和夜间浮动实习生确定在覆盖期间发生的任何与签出有关的问题，并确定相关的签出不足之处。我们通过审查每个相应的口头和书面签出，验证了报告的签出不足之处。然后，我们开发了一个分类的错误类型及其后果，通过迭代codingprocess.Results：签出会话（N = 88）包括503例患者签出。共有184名患者在同一天晚上两次登记出院。因此，数据集中有319个独特的患者日。我们采访了84 88（95%）的签字退出会议的实习收件人有关的签字退出问题。Postcall实习生确定了24个与签出相关的问题，我们可以验证签出不足之处。5名患者延误诊断或治疗，导致1名患者转入重症监护室，4名患者险些死亡。此外，内务部工作人员经历了15次工作效率低下或冗余。签出省略的关键信息，如患者的临床状况，最近或预定的事件，任务完成，预期的指导，并指定tasks.Conclusion的行动和理由的具体计划：在签出的关键信息的省略可以有重要的不良后果，为患者和医疗保健提供者。
Background: In case reports, transfers in the care of patients among health care providers have been linked to adverse events. However, little is known about the nature and frequency of these transfer-related problems.Methods: We conducted a prospective audiotape study of 12 days of "sign-out" of clinical information among 8 internal medicine house-staff teams. Each day, postcall and night-float interns were asked to identify any sign-out-related problems occurring during the coverage period and to identify the associated sign-out inadequacies. We verified reported sign-out inadequacies by reviewing each corresponding oral and written sign-out. We then developed a taxonomy of types of errors and their consequences through an iterative coding process.Results: Sign-out sessions (N = 88) included 503 patient sign-outs. A total of 184 patients were signed out twice in the same night. Thus, there were 319 unique patient-days in the data set. We interviewed intern recipients of 84 of 88 sign-out sessions (95%) about sign-out related problems. Postcall interns identified 24 sign-out related problems for which we could verify sign-out inadequacies. Five patients suffered delays in diagnosis or treatment, resulting in 1 intensive care unit transfer, and 4 patients had near misses. In addition, house staff experienced 15 inefficiencies or redundancies in work. Sign-outs omitted key information, such as the patient's clinical condition, recent or scheduled events, tasks to complete, anticipatory guidance, and a specific plan of action and rationale for assigned tasks.Conclusion: Omission of key information during sign-out can have important adverse consequences for patients and health care providers.