Generic Handover Investigation (GHandI)

将系统的责任从一个人或团队移交给另一个人或团队对工作的安全性和有效性做出了重要贡献。在Piper Alpha灾难等备受瞩目的灾难中，贫困人口已被确定为促成因素。最近，随着2004年《欧洲工作时间指令》的实施，医疗保健部门的工作人员受到了严格审查，该指令导致对初级医院医生实行轮班制，以减少他们的工作时间。这导致轮班频率相应增加，并使有效的临床交接变得更加必要。然而，目前的做法是高度可变的：它从病房到病房和医院到医院。交接通常是即兴的、非正式的，并有临时的人工制品，如纸质笔记。这反映了这样一个事实，即对病人安全这一关键方面的研究少得令人惊讶，虽然有一些特定环境下的临床移交的小规模研究，包括我们自己在ACE项目中对儿科病房的研究，但缺乏基础研究。我们将通过对移交的广泛调查来解决GHandI项目中的这一缺陷，因为只有对移交完成的“工作”有了清楚的了解，我们才能改进实践。例如，有证据表明，移交工作有助于病人的安全，因为它完成了病人护理责任的立即移交以外的工作。正是在这种背景下，目前的建议是位于，其总体目标是进行详细的调查临床移交及其对患者安全的贡献，通过开发和评估一个通用的理论模型移交，并得出详细的建议和原型的创新移交支持技术。这被分解为以下目标：1。从社会技术系统的角度开发一个通用的临床移交模型，以捕捉其许多共性和变化。这将在实践和理论两个层面上实现。设计和评估创新切换支持技术的原型，整合1和3.3的结果。探讨简单的代码和图形语言在改善沟通和减少歧义的信息资源中的作用.为了调查有效移交的性质，并确定如何衡量这一点。为了在真正理解工作的基础上进行建模和设计活动，我们将在一系列非常不同的环境中对临床移交进行详细研究。在我们合作者的支持下，我们计划在10个临床环境中研究急诊，从救护车“检索”服务到儿科重症监护病房的跨专业转移到轮班。这本身将是一个重要的贡献，从GHandI.这项研究的结果将直接受益于医疗保健部门，无论是现场研究设置和NHS更普遍。他们将受益于对移交的更好理解、有效做法的指导和原型移交技术。改进的医疗服务将提高患者的安全性，从而提高生活质量，改进的工作实践将有利于临床工作人员。结果，特别是建模工作，也将是相关的其他关键领域，在这些领域中，操作员之间的相互协作对工作的安全性和有效性做出了重要贡献，例如，连续过程工业。最后，HCI和CSCW学术界将受益于理论建模工作，从这种特殊形式的协作工作的详细研究和图形通信工具的调查。

Handover of responsibility for a system from one individual or team to another makes a vital contribution to the safety and effectiveness of the work. Poor handovers have been identified as contributory causal factors in high profile disasters such as the Piper Alpha Disaster. Recently, handovers in the healthcare sector have come under scrutiny with the implementation in 2004 of the European Working Time Directive, which resulted in the introduction of shift working for junior hospital doctors in order to reduce their working hours. This saw a corresponding increase in the frequency of shift changeovers and made effective clinical handover all the more imperative. Yet current practice is highly variable: it varies from ward to ward and hospital to hospital. Handovers are often impromptu, informal and supported by ad hoc artefacts such as paper-based notes. This is a reflection of the fact that there has been surprisingly little research into this crucial aspect of patient safety.While there have been small-scale studies of clinical handover in specific settings, including our own study of a paediatric ward on the ACE project, there is a lack of basic research. We will address this shortcoming in the GHandI project with an extensive investigation of handover as it is only by achieving a clear understanding of the 'work' that handover accomplishes that we will be able to improve the practice. For example, there is evidence that handover contributes to patient safety by accomplishing work other than the immediate transfer of responsibility for care of the patient. It is within this context that the current proposal is situated, the overall aim of which is to conduct a detailed investigation of clinical handover and its contribution to patient safety by developing and evaluating a generic theoretical model of handover and deriving detailed recommendations and prototypes for innovative handover support technology. This is decomposed into the following objectives:1. To develop a generic model of clinical handover from a socio-technical system perspective that will capture its many commonalities and variations. This will be achieved at both practical and theoretical levels.2. To design and evaluate prototypes for innovative handover support technologies, integrating results from 1 and 3.3. To investigate the role of simple codes and graphic languages in improving communication and reducing ambiguity in information resources used in clinical handover.4. To investigate the nature of an effective handover and determine how this can be measured.In order to ground the modelling and design activities in a genuine understanding of the work, we will undertake a detailed study of clinical handover in a range of very different settings. With the support of our collaborators, we plan to study handovers in ten clinical settings, ranging from ambulance 'retrieval' services to inter-specialty transfers to shift handovers in paediatric intensive care units. This in itself will be an important contribution from GHandI.The outcomes of this research will be of direct benefit to the healthcare sector, both the field study settings and the NHS more generally. They will benefit from an improved understanding of handover, from guidance on effective practice and from the prototype handover technologies. Improved handovers will enhance patient safety, and therefore the quality of life, and improved working practices will be of benefit to clinical staff. The results, particularly the modelling work, will also be of relevance to other critical domains where handovers between operators make an important contribution to the safety and effectiveness of the work, e.g. the continuous process industries. Finally, the HCI and CSCW academic communities will benefit from the theoretical modelling work, from the detailed study of this particular form of collaborative work and from the investigation of graphical communication tools.