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1.
Nurs Clin North Am ; 54(3): 313-323, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31331619

RESUMO

The burden of neurologic disease in the United States continues to increase due to a growing older population, increased life expectancy, and improved mortality after cancer and cardiac disease. Emergency medical services (EMS) providers are responding to more patients with stroke, traumatic neurologic injury, neuromuscular weakness, seizure, and spontaneous cardiac arrest. Efficient prehospital care and triage to facilities with specialized services improve outcomes. Effective handoff from EMS to an emergency department ensures continuity of care and patient safety. Although advancements in prehospital cardiopulmonary resuscitation have increased rates of return to spontaneous circulation, a large proportion of patients sustain neurologic injury.


Assuntos
Continuidade da Assistência ao Paciente/normas , Serviços Médicos de Emergência/normas , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Transferência da Responsabilidade pelo Paciente/normas , Guias de Prática Clínica como Assunto , Triagem/normas , Humanos , Estados Unidos
2.
Nurs Clin North Am ; 54(3): 335-345, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31331621

RESUMO

Handoff of patients from the operating room to the intensive care unit is a complex process. It involves 2 teams of caregivers, the physical relocation of the patient and monitoring equipment, and tight time constraints. Research and quality projects have focused on checklists and protocols to standardize handoff processes and content. Interventions also include requiring all team members be present, a team leader identified, and prehandoff communication. Outcome evaluation is limited by lack of standardized outcomes to define a good handoff. Instead, handoff content is often used as a proxy. Studies with larger sample sizes using rigorous methods are needed.


Assuntos
Continuidade da Assistência ao Paciente/normas , Unidades de Terapia Intensiva/normas , Comunicação Interdisciplinar , Colaboração Intersetorial , Salas Cirúrgicas/normas , Transferência da Responsabilidade pelo Paciente/normas , Guias de Prática Clínica como Assunto , Humanos
3.
J Grad Med Educ ; 11(3): 301-306, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31210861

RESUMO

Background: A formal handoff process, such as the I-PASS handoff program, can improve communication about patients among residents. Faculty observation of resident handoffs has served as the primary method for documenting adherence to I-PASS, and little is known about residents' use when they are not being observed. Objective: We determined how frequently pediatric residents use I-PASS when not being observed. Methods: We implemented I-PASS in the 2016-2017 academic year and anonymously surveyed residents (December 2016 and June 2017), asking them how they perceive the effectiveness of I-PASS at enhancing patient safety, their frequency of I-PASS use when not observed, co-residents' frequency of use, and open-ended questions regarding factors affecting use. Results: Fifty-one (52%) and 50 (51%) of 99 eligible residents completed the December and June surveys, respectively. All respondents thought I-PASS had some effectiveness in enhancing patient safety. In December, only 6 (12%) residents stated they used I-PASS more than 75% of the time and reported providing a synthesis statement during handoffs more than 75% of the time. The results were similar for both surveys. Commonly cited reasons for not using I-PASS included time (n = 30), prior knowledge of patients (n = 20), and patients with limited complexity (n = 9). Conclusions: While most residents thought I-PASS was effective at enhancing patient safety, many reported that they do not use all 5 elements in most of their handoffs when not being observed. Barriers reported included time, familiarity with patients, and limited patient complexity.


Assuntos
Transferência da Responsabilidade pelo Paciente/normas , Segurança do Paciente , Continuidade da Assistência ao Paciente/organização & administração , Hospitais Pediátricos , Humanos , Internato e Residência/métodos , Maryland , Pediatria/educação , Pediatria/métodos , Inquéritos e Questionários
4.
Pediatr Clin North Am ; 66(4): 751-773, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31230621

RESUMO

Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.


Assuntos
Comunicação Interdisciplinar , Transferência da Responsabilidade pelo Paciente/normas , Pediatria/normas , Medicina Baseada em Evidências , Humanos , Erros Médicos/prevenção & controle , Cultura Organizacional , Pacotes de Assistência ao Paciente/normas , Segurança do Paciente/normas , Melhoria de Qualidade
6.
GMS J Med Educ ; 36(2): Doc19, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30993177

RESUMO

Objective: The handover of patients to medical colleagues and to members of other professional groups is a central task in the medical care process for patient safety. Nevertheless, little is known about teaching and testing on the subject of handing over. The present article therefore examines the extent to which handover is the subject of teaching and examinations at medical faculties in Germany. Methodology: In 31 medical faculties the teachers were asked about the implementation of the NKLM learning objectives in the area of communication. The survey was conducted within the framework of group interviews with lecturers, in which it was determined whether each learning objective of the NKLM (National Competency-based Catalogue of Learning Objectives in Medicine) on the subject of communication, is explicitly taught in lectures and examinations at the respective faculty. Results: The learning objective "transfer to medical colleagues" is covered by 19 faculties, while the learning objective of interprofessional transfer is covered by 14 faculties. There are examinations for transfer to medical colleagues and interprofessional transfer at two faculties. There is a highly significant relationship between the total number of communicative learning objectives that are put into practice in a faculty and the coverage of the learning objectives for handover. Conclusions: In the field of communications, the subject of handover is less frequently taught at the faculties and, more importantly, it is less frequently examined than other NKLM contents. This is particularly evident in the interprofessional area. The subject is more likely to be taught as a handover between physicians, while the interprofessional interfaces attract less attention. In terms of patient safety, it would be desirable to give a higher priority to the subject of handover. An inter-faculty exchange and the inclusion of the subject of intra- and interprofessional transfer in state examinations could give the implementation process at the faculties a decisive impetus.


Assuntos
Transferência da Responsabilidade pelo Paciente/normas , Currículo/normas , Currículo/tendências , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/normas , Avaliação Educacional/métodos , Alemanha , Humanos , Inquéritos e Questionários
8.
Contemp Nurse ; 55(1): 83-94, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30975066

RESUMO

Background: Nursing handovers provide critical information on the patient, requiring special communication skills and techniques between the nurses' shift-change. Aim: Current study investigates the experiences/views of nurses regarding the handover process. Methods: An observation method was applied assesing 22 interviews using a semi-structured questionnaire and an audio recording system throughout mixed content analysis. Results: Nursing handover mainly involves medical instructions, detailed records of each patient's general condition or drug administration guidelines. Nurses determined which pieces of information were significant to transfer to the next shift were the medical instructions, the patient's hemodynamic condition and the care plans implemented by the previous nurse. The information was mainly drawn from events occurring in the previous 24 h, from the medical instructions, or the doctors and the nursing outcomes, and to a lesser extent from the events of the previous shifts and the nursing folders. None of the participants had received, as they stated, any training in the handover process. Conclusions: It is highlighting the importance of organized, standardized and up-to-date handovers, and the fundamental part they play in the health care system.


Assuntos
Recursos Humanos de Enfermagem no Hospital/psicologia , Transferência da Responsabilidade pelo Paciente , Adulto , Feminino , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Transferência da Responsabilidade pelo Paciente/normas , Segurança do Paciente , Qualidade da Assistência à Saúde , Inquéritos e Questionários
9.
J Nurs Manag ; 27(5): 1055-1063, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30963652

RESUMO

AIM: Different designs of electronic hand-off systems might have different levels of effectiveness; this study validated the effectiveness of systems with an Identify, Situation, Background, Assessment and Recommendation (ISBAR) design to one without such a design. BACKGROUND: Adverse consequences in hospital commonly occur when there are breakdowns in the transmission of information between team members. To ensure information accuracy and consistency, some Taiwan hospitals implemented electronic hand-off systems. However, the effectiveness of such systems was not investigated. METHODS: A quasi-experiment was conducted to the nurses of two Taiwan case hospitals, one with ISBAR and the other with non-ISBAR design systems and 200 questionnaires were used to collect data. RESULTS: The respondent rate was 72%. Using system with ISBAR design, nurses can enhance their communication effectiveness and further increase their individual benefits at hand-off. Using a non-ISBAR hand-off system, communication effectiveness depends solely on the nurses' individual cognitive and expressive ability. CONCLUSION: System with ISBAR design can ensure effective information transmission among nurses for care continuity and prevention of adverse events. IMPLICATIONS FOR NURSING MANAGEMENT: Ensuring the design of electronic systems is adequate, nursing managers can save nurses' time and effort while using the system to perform their regular work effectively and gain competitive advantage.


Assuntos
Comunicação , Equipamentos e Provisões Elétricas/normas , Transferência da Responsabilidade pelo Paciente/normas , Adulto , Equipamentos e Provisões Elétricas/tendências , Feminino , Humanos , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Transferência da Responsabilidade pelo Paciente/estatística & dados numéricos , Inquéritos e Questionários , Taiwan
13.
Adv Emerg Nurs J ; 41(1): 43-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30702533

RESUMO

This article discusses the implementation of 3 targeted interventions aimed at reducing infection rates in patients due to prolonged in situ intravascular catheters (IVCs) during their admission to the hospital. These IVCs are inserted by paramedics with Queensland Ambulance Service (QAS) in prehospital settings. The 3 interventions involved were the application of "QAS-IVC" stickers by QAS paramedics to indicate QAS-inserted IVCs, the implementation of mandatory IVC documentation during patient handover, and clinician engagement to provide patient education on IVC infection signs. Audits undertaken in wards reflected that the interventions were apparent and beneficial; this is evident from the limited number of patients having in-dwelling QAS-IVC and increased awareness among medical staff and patients alike. We, however, did not have comparative data to objectively quantify the success of the interventions implemented.


Assuntos
Ambulâncias/normas , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/normas , Serviços Médicos de Emergência/normas , Transferência da Responsabilidade pelo Paciente/normas , Melhoria de Qualidade , Remoção de Dispositivo/normas , Documentação/normas , Humanos , Queensland
14.
Diagnosis (Berl) ; 6(3): 269-276, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-30753157

RESUMO

Background Communication and handoff failures are common causes of diagnostic errors in hospital. Human quest for certainty can increase the likelihood of premature closure in decision-making, the most common phenomenon in misdiagnosis. Little research exists on whether language choice in handoffs affects physicians' sense of uncertainty. Methods Medical students from a large US medical school were randomized to receive one of four language variations describing a presumed diagnosis in hypothetical handoffs from emergency department (ED) to inpatient ward. The control language arm used the word 'diagnosis'; experimental arms replaced this word with either 'hypothesis', 'probability of 60%', or 'working diagnosis' with a short differential. Outcome measures were students' anxiety due to uncertainty (range 5-30; higher scores indicating higher stress from uncertainty) and clinical uncertainty about the ED provider's presumed diagnosis. Results Mean anxiety due to uncertainty was significantly higher in subjects receiving the 'hypothesis' language arm compared to those receiving the control 'diagnosis' language [19.2 (4.6) vs. 15.5 (3.4); p<0.008]. Differences between subjects who received the probability language [17.2 (5.8) vs. 15.5 (3.4); p=0.26] and 'working diagnosis' language [16 (5) vs. 15.5 (3.4); p=0.69] were not statistically significant. There was no difference in items assessing clinical uncertainty after each scenario. Conclusions The word 'hypothesis' increased anxiety due to uncertainty compared to the word 'diagnosis', but did not change assessments of clinical uncertainty. Further research is needed to assess how use of language in clinical handoffs may influence perceptions and anxiety related to uncertainty and whether optimal language can be identified that leads to recognition of uncertainty without maladaptive stress or anxiety due to uncertainty.


Assuntos
Ansiedade/psicologia , Comunicação , Linguagem , Transferência da Responsabilidade pelo Paciente/normas , Estudantes de Medicina/psicologia , Incerteza , Adulto , Tomada de Decisão Clínica , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino
15.
J Nurses Prof Dev ; 35(2): E6-E14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30762843

RESUMO

Compliance with evidence-based shift report practices varies, and handoff processes are often inconsistent, increasing the risk for compromised patient safety. This pilot study evaluated registered nurse adherence to and self-efficacy with evidence-based shift report practices presimulation and postsimulation. Statistically significant increases in adherence to and self-efficacy with shift report practices after simulation were noted. Simulation offers nursing professional development practitioners a feasible method to enhance practice competency and standardization of care during registered nurse shift report.


Assuntos
Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem no Hospital/educação , Transferência da Responsabilidade pelo Paciente/normas , Treinamento por Simulação/métodos , Hospitais , Humanos , Pessoa de Meia-Idade , Avaliação em Enfermagem , Segurança do Paciente , Projetos Piloto , Relatório de Pesquisa , Autoeficácia , Inquéritos e Questionários
16.
Med J Aust ; 210(5): 220-226, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30656692

RESUMO

OBJECTIVE: To examine the frequency of and rationale for hospital doctors mentioning a patient's cultural heritage (ethnicity, national heritage, religion) during medical handovers and in medical records. DESIGN: Four-phase observational study, including the covert observation of clinical handovers in an acute care unit (ACU) and analysis of electronic medical records (EMRs) of ACU patients after their discharge to ward-based care. SETTING, PARTICIPANTS: 1018 patients and the doctors who cared for them at a tertiary hospital in Western Australia, May 2016 - February 2018. MAIN OUTCOME MEASURE: References to patients' cultural heritage by ACU doctors during clinical handover (written or verbal) and by ward-based doctors in hospital EMRs (written only), by geographic ethnic-national group. RESULTS: In 2727 ACU clinical handovers of 1018 patients, 142 cultural heritage identifications were made (ethnicity, 84; nationality, 41; religion, 17); the rate was highest for Aboriginal patients (370 [95% CI, 293-460] identifications per 1000 handovers). 14 505 EMR pages were reviewed; 380 cultural heritage identifications (ethnicity, 257; nationality, 119; religion, 4) were recorded. A rationale for identification was documented for 25 of 142 patients (18%) whose ethnic-national background was mentioned during handover or in their EMR. Multivariate analysis (adjusted for demographic, socio-economic and medical factors) indicated that being an Aboriginal Australian was the most significant factor for identifying ethnic-national background (handovers: adjusted odds ratio [aOR], 21.7; 95% CI, 7.94-59.4; hospital EMRs: aOR, 13.6; 95% CI, 5.03-36.5). 44 of 75 respondents to a post-study survey (59%) were aware that Aboriginal heritage was mentioned more frequently than other cultural backgrounds. CONCLUSIONS: Explicitly mentioning the cultural heritage of patients is inconsistent and seldom explained. After adjusting for other factors, Aboriginal patients were significantly more likely to be identified than patients with other backgrounds.


Assuntos
Registros Eletrônicos de Saúde/normas , Grupos Étnicos/classificação , Grupo com Ancestrais Oceânicos/classificação , Transferência da Responsabilidade pelo Paciente/normas , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transferência da Responsabilidade pelo Paciente/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Austrália Ocidental
18.
J Nurs Manag ; 27(4): 815-832, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30615230

RESUMO

AIM: To map the research methods, frameworks, structures, processes and outcomes investigated to date when implementing nursing bedside shift reports (BSRs). BACKGROUND: BSRs have become an area of increased interest among nurse managers (NMs) with several projects aiming at implementing bedside reports also as a strategy to increase nursing surveillance and reduce adverse events. However, to date, no summary of the available evidence has been provided with regard to research methods, theoretical frameworks underpinning BSR implementation and outcomes aiming at supporting NM decision-making in this field. EVALUATION: A scoping review including quantitative studies written in English and retrieved from five databases was performed in 2018. KEY ISSUES: Twenty-two studies originating from USA, Australia, Finland and Sweden, largely monocentric in nature and involving mainly medical/surgery units, have been performed to date. BSR implementation has been conducted mainly under organisational change theories, patient safety and nursing conceptual models. The BSR outcomes have been measured at the patient, nurse and organisational levels and reported positive trends. CONCLUSION: Professional reports-describing success transitions from traditional methods of handover to BSRs, and scientific studies aimed at improving evidence in the field, have been conducted to date, in order to document BSR implementation processes and outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: BSRs should be designed and conducted under a theory of organisational change; moreover, clinical nurses should be trained and supported in the transition from the traditional shift report to the BSR; while implementing this transition, outcomes should be set at the patient, nurses and organisational levels with the aim of tracing the comprehensive effects of the change.


Assuntos
Processo de Enfermagem/normas , Transferência da Responsabilidade pelo Paciente/normas , Humanos , Processo de Enfermagem/tendências , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/tendências
19.
Adv Health Sci Educ Theory Pract ; 24(2): 301-315, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30539343

RESUMO

Direct observation of clinical skills is central to assessment in a competency-based medical education model, yet little is known about how direct observation is experienced by trainees and observers. The objective of the study is to explore how direct observation was experienced by residents and faculty in the context of the I-PASS Handoff Study. In this multi-center qualitative study, we conducted focus groups and semi-structured interviews of residents and faculty members at eight tertiary pediatric centers in North America that implemented the I-PASS Handoff Bundle. We employed qualitative thematic analysis to interpret the data. Barriers to and strategies for direct observation were described relating to the observer, trainee, and clinical environment. Residents and faculty described a mutual awareness that residents change their performance of handoffs when observed, in contrast to their usual behavior in a clinical setting. Changes in handoff performance may depend on the nature of the observer or 'audience'. Direct observation also highlighted the importance of handoffs to participants, recognized as a clinical activity that warrants feedback and assessment. Dramaturgical theory can be used to understand our finding of 'front-stage' (observed) versus 'backstage' (unobserved) handoffs as distinct performances, tailored to an "audience". Educators must be cognizant of changes in performance of routine clinical activities when using direct observation to assess clinical competence.


Assuntos
Competência Clínica/normas , Docentes de Medicina/normas , Internato e Residência/normas , Observação , Transferência da Responsabilidade pelo Paciente/normas , Educação Baseada em Competências , Documentação , Meio Ambiente , Hospitais Pediátricos/normas , Humanos , Entrevistas como Assunto , América do Norte , Pesquisa Qualitativa , Estresse Psicológico/epidemiologia , Fatores de Tempo
20.
Clin Teach ; 16(2): 114-119, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29600582

RESUMO

BACKGROUND: Emergency Medicine (EM) and Hospital Medicine (HM) providers frequently interact when transitioning patients from the emergency department (ED) to the inpatient unit; however, there is infrequent collaboration between these subspecialties, and effective communication in EM-HM provider handover is an area for improvement. Shared mental models can enhance communication and safety. The purpose of this article is to describe the implementation of an interdisciplinary conference to allow providers to create shared mental models, and to assess the impact on attitudes and behaviours towards communication and collaboration outside the competing attentions of patient care environments. METHODS: The authors instituted a quarterly interactive case-based conference at an academic tertiary care children's hospital in which EM and HM subspecialty trainees co-facilitate evidence-based interactive presentations of clinical, diagnostic or management dilemmas. The conferences were evaluated via repeated cross-sectional surveys of EM and HM providers, as well as session evaluations. Surveys included multiple-choice, Likert-scale and free-text responses to assess the degree of interaction and collaboration between the divisions and provider attitudes toward changes in clinical practice. RESULTS: Assessment of the EM-HM collaborative conferences demonstrated trends towards increased interaction between divisions and increased discussion about management decisions among colleagues. Two-thirds of individuals who attended at least one conference felt that having attended an interdisciplinary conference influenced future management decisions. Effective communication in EM-HM provider handover is an area for improvement CONCLUSIONS: Interdisciplinary conferences provide a forum for cross-specialty communication to discuss management differences in a low-stress educational environment, and allow providers to develop shared mental models for effective, safe patient care.


Assuntos
Medicina de Emergência/educação , Medicina Hospitalar/educação , Relações Interprofissionais , Modelos Psicológicos , Transferência da Responsabilidade pelo Paciente/organização & administração , Centros Médicos Acadêmicos/organização & administração , Comunicação , Comportamento Cooperativo , Estudos Transversais , Tomada de Decisões , Hospitais Pediátricos/organização & administração , Humanos , Transferência da Responsabilidade pelo Paciente/normas
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