Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 309
Filtrar
1.
Isr Med Assoc J ; 11(22): 700-703, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33249791

RESUMO

BACKGROUND: Burn injuries are an extreme form of traumatic injury and are a global health issue. The Israeli National Burn Unit at the Sheba Medical Center, a tertiary level 1 trauma center and hence the national referral center, treats burn patients admitted both directly and referred from other medical centers. The transfer and handover of patients is a critical step in patient care. In Israel, to date, there is no standardized and accepted transfer request form for burn patients from one medical facility to another. OBJECTIVES: To construct a transfer request form to be used in all future burn patient referrals. METHODS: After reviewing publicly available international transfer forms and comparing them to the admission checklist used at our unit, a structured transfer request form was constructed. RESULTS: After a pilot study period, testing the form in various scenarios and adapting it, the first standardized transfer form for burn patients in Israel in both English and Hebrew was implemented beginning May 2020. CONCLUSIONS: Implementation of a standardized transfer process will improve communication between healthcare professionals to help maintain a continuum of care. We believe that implementation of a burn transfer form in all future referrals can standardize and assure better care for burn patients, thus improving overall patient care.


Assuntos
Unidades de Queimados/organização & administração , Formulários como Assunto , Transferência da Responsabilidade pelo Paciente/organização & administração , Transferência de Pacientes/organização & administração , Encaminhamento e Consulta/organização & administração , Lista de Checagem , Humanos , Israel , Transferência da Responsabilidade pelo Paciente/normas , Transferência de Pacientes/normas , Projetos Piloto , Encaminhamento e Consulta/normas
2.
Nephrol Nurs J ; 47(5): 439-445, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107716

RESUMO

This quality improvement project aimed to increase patient safety by preventing errors through improving staff handoff communication in an outpatient hemodialysis unit. Lewin's theory of planned change was applied. Staff familiarity with the situation-background-assessment-recommendation (SBAR) communication format was assessed. Education regarding SBAR format and supporting tools was provided to staff prior to implementing the SBAR handoff format. Safety incidences were compared pre- and post-implementation. Data analysis supported a statistically significant improvement in reported error rates post implementation (p = 0.000). Implementing a standardized handoff communication form provided a mechanism for improving patient safety.


Assuntos
Comunicação , Transferência da Responsabilidade pelo Paciente/organização & administração , Segurança do Paciente , Melhoria de Qualidade , Diálise Renal , Humanos
3.
Hu Li Za Zhi ; 67(5): 65-73, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-32978767

RESUMO

BACKGROUND & PROBLEMS: Efficient handover is essential to ensuring high levels of caring quality and patient safety. In our psychiatric acute ward, it was noticed that there were many valueless tasks being performed during the nursing handover process that negatively affected efficiency. PURPOSE: To apply lean management principles to improve the nursing handover process in the psychiatric acute ward. RESOLUTION: In order to find the rightful solution, our task team analyzed the problem using the Value Chart of Lean Management and detected that the handover process was slowed down by motion, waiting, and defects. According to the rules of lean management, group discussion, decision making, and the cost-benefit matrix, we proposed improvement solutions including visual stocktaking, adjusting handover patterns, switching the handover location, and systematizing nursing handover procedures. RESULTS: The time required for stocktaking was shortened from 5 to 2 minutes (60% improvement). The waiting time was shortened from 114 to 49.6 minutes (56.6% improvement). The efficiency of the handover process increased from 66% to 90%. CONCLUSIONS: Applying lean management principles helped detect critical problems and reduce waste, which enhanced efficiency, improved handover, and helped maximize nursing value and benefit in an increasingly complex environment.


Assuntos
Unidades Hospitalares/organização & administração , Transtornos Mentais/enfermagem , Transferência da Responsabilidade pelo Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Eficiência Organizacional/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem
4.
Emerg Med J ; 37(7): 407-410, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32467156

RESUMO

The COVID-19 outbreak has posed unique challenges to the emergency department rostering. Additional infection control, the possibility of quarantine of staff and minimising contact among staff have significant impact on the work of doctors in the emergency department. Infection of a single healthcare worker may require quarantine of close contacts at work. This may thus affect a potentially large number of staff. As such, we developed an Outbreak Response Roster. This Outbreak Response Roster had fixed teams of doctors working in rotation, each team that staff the emergency department in turn. Members within teams remained constant and were near equally balanced in terms of manpower and seniority of doctors. Each team worked fixed 12 hours shifts with as no overlapping of staff or staggering of shifts. Handovers between shifts were kept as brief as possible. All these were measures to limit interactions among healthcare workers. With the implementation of the roster, measures were also taken to bolster the psychological wellness of healthcare workers. With face-to-face contact limited, we also had to maintain clear, open channels for communication through technology and continue educating residents through innovative means.


Assuntos
Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/terapia , Betacoronavirus , Esgotamento Profissional/prevenção & controle , Comunicação , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Pessoal de Saúde/organização & administração , Pessoal de Saúde/psicologia , Humanos , Capacitação em Serviço/organização & administração , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Pneumonia Viral/prevenção & controle , Singapura , Fatores de Tempo , Fluxo de Trabalho
5.
Am J Emerg Med ; 38(7): 1494-1503, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32321683

RESUMO

BACKGROUND: Handovers of care are necessary, yet a vulnerable time for patient safety. They can either reduce the risk of medical error during transitions of care or cause direct medical or financial harm to patients due to poor communication. OBJECTIVE: To review (1) observational studies that quantify the frequency of transfer of specific data points or clinician retention of information provided in prehospital verbal handoff to assess the state of EMS-to-ED handoffs; (2) surveys and interviews of prehospital and ED staff perceptions of the handover process and any perceived barriers to optimal handover found therein; (3) interventional studies that have aimed to improve the quality of EMS to ED handoffs. METHODS: A systematic review of the literature was performed using Pubmed, Web of Science, Google Scholar, and Cochrane Database of Systematic Reviews and by hand-searching references of relevant articles. Articles were selected that focused on verbal and/or written handover of patient care from EMS to ED providers and that addressed the above goals. Qualitative data was extracted from the articles and assessed using thematic synthesis. RESULTS: 78 articles were identified for full text review, 60 of which met inclusion criteria. Four categories of barriers emerged on thematic synthesis: educational, operational, cultural, and cognitive. Within these categories, 12 initial descriptive themes and 9 suggested interventions were identified. CONCLUSIONS: Descriptive themes of disrespect & disinterest, environmental factors, redundancy, poor recall, conflicting goals and perspectives, technological issues, information degradation, information loss, lack of standardization, lack of training, delays, and lack of feedback were identified as barriers to effective EMS to ED handovers. Three categories of interventions were identified across the included interventional studies, namely technological, educational, and changes to cultural customs.


Assuntos
Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Transferência da Responsabilidade pelo Paciente/organização & administração , Humanos
6.
J Nurs Adm ; 50(3): 174-181, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32068626

RESUMO

OBJECTIVE: Rush University Medical Center nursing leadership undertook a process improvement project to revamp nursing handoff during unit transfer with the goal of improving patient throughput. The aim was to decrease assign-to-occupy time, the duration from bed assignment to bed occupancy. BACKGROUND: There was a lengthy lag time in admitting/transferring patients, leading to delays in patient throughput and potential threats to patient safety. In fiscal year 2016, assign-to-occupy time averaged 97 minutes. The goal was to decrease that time to 60 minutes or less. METHODS: Process improvement leaders held a rapid improvement event to determine viable solutions. A team then standardized handoff workflow; created an electronic tool, virtually eliminating verbal report; and implemented a new handoff process. RESULTS: Assign-to-occupy time at 1 year after go-live averaged 55 minutes, and it has been staying less than 60 minutes since the implementation. CONCLUSIONS: Key success strategies included engaging stakeholders during the rapid improvement event, imploring frontline nurses to create and promote the revised process to facilitate staff engagement, and leveraging electronic health records.


Assuntos
Eficiência Organizacional/normas , Registros Eletrônicos de Saúde/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Transferência de Pacientes/organização & administração , Centros Médicos Acadêmicos/organização & administração , Humanos , Avaliação de Resultados em Cuidados de Saúde , Segurança do Paciente/normas , Melhoria de Qualidade , Fluxo de Trabalho
7.
J Clin Nurs ; 29(13-14): 2231-2238, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32043671

RESUMO

AIM AND OBJECTIVE: To explore nurses' perceptions of factors that help or hinder intra-hospital handover. BACKGROUND: Miscommunication during clinical handover is a leading cause of clinical incidents in hospitals. Intra-hospital nursing handover between the emergency department and inpatient unit is particularly complex. DESIGN: A descriptive, qualitative study. This research adheres to the consolidated criteria for reporting qualitative research. METHODS: Forty-nine nurses participated in group interviews, which were analysed using inductive content analysis. RESULTS: Three categories emerged: (a) "lacking clear responsibilities for who provides handover"; (b) "strategies to ensure continuity of information"; and (c) "strained relationships during handover." CONCLUSIONS: Intra-hospital handover requires clear processes, to promote high-quality information sharing. Ensuring these processes are broad and acceptable across units may ensure nurses' needs are met. Relational continuity between nurses is an important consideration when improving intra-hospital handover. RELEVANCE TO CLINICAL PRACTICE: Nursing managers are optimally positioned to enhance intra-hospital handover, by liaising and enforcing standardisation of processes across units. Nurse managers could promote intra-unit activities that foster front-line nurses' communication with each other, to encourage problem-solving and partnerships.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
8.
BMJ Qual Saf ; 29(2): 135-141, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31270253

RESUMO

OBJECTIVE: Handoffs are often framed as the co-construction of a shared understanding relying on narrative storytelling. We investigated how narratives are constructed and used during resident and nurse handoff conversations. METHOD: We audio-recorded resident (n=149) and nurse (n=126) handoffs in an inpatient medicine unit. Qualitative analysis using grounded theory was conducted to identify and characterise the structure of resident and nursing handoff narratives. RESULTS: Handoff conversations among both residents and nurses used three types of narratives: narratives on creating clinical imagery, narratives on coordinating care continuity and narratives on integrating contextual aspects of care. Clinical imagery narratives were common during patient introductions: residents used a top-down approach relying on overarching patient clinical situations (eg, 'a liver patient'), whereas nurses used a bottom-up approach using patient-specific identifying information. Narratives on the coordination of care continuity for residents focused on managing internal and external coordination activities, whereas nurse narratives focused on internal coordination, emphasising their role as an interface between patients and their physicians. Both resident and nurse narratives on the contextual aspects of care had considerable focus on highlighting 'heads up' anticipatory information and personal patient information; such information was often not present in patient charts, but was important for ensuring effective care management. DISCUSSION: The presence of narrative structures highlights the need for new perspectives for the design of handoff tools that allow for both informational and cognitive support and shared awareness among conversational partners during handoff conversations. We discuss the implications of the use of narratives for patient safety and describe specific design considerations for supporting narrative interactions during handoffs.


Assuntos
Comunicação Interdisciplinar , Medicina Interna/métodos , Narração , Transferência da Responsabilidade pelo Paciente/organização & administração , Relações Médico-Enfermeiro , Continuidade da Assistência ao Paciente , Feminino , Teoria Fundamentada , Humanos , Pacientes Internados/estatística & dados numéricos , Internato e Residência , Masculino , Enfermeiras e Enfermeiros , Equipe de Assistência ao Paciente/organização & administração , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Gravação em Vídeo
9.
Ann Thorac Surg ; 109(6): 1782-1788, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31706873

RESUMO

BACKGROUND: The ability of handoff redesign to improve short-term outcomes is well established, yet an effective approach for achieving widespread adoption is unknown. An implementation science-based approach capable of influencing the leading indicators of widespread adoption was used to redesign handoffs from the cardiac operating room to the intensive care unit. METHODS: A transdisciplinary, unit-based team used a 12-step implementation process. The steps were divided into 4 phases: planning, engaging, executing, and evaluating. Based on unit-determined best practices, a "handoff bundle" was designed. This included team training, structured education with video illustration, and cognitive aids. Fidelity and acceptability were measured before, during, and after the handoff bundle was deployed. RESULTS: Redesign and implementation of the handoff process occurred over 12 months. Multiple rapid-cycle process improvements led to reductions in the handoff duration from 12.6 minutes to 10.7 minutes (P < .014). Fidelity to unit-determined handoff best practices was assessed based on a sample of the cardiac surgery population preimplantation and postimplementation. Twenty-three handoff best practices (information and tasks) demonstrated improvements compared with the preimplementation period. Provider satisfaction scores 2.5 years after implementation remained high compared with the redesign phase (87 vs. 84; P = .133). CONCLUSIONS: The use of an implementation-based approach for handoff redesign can be effective for improving the leading indicators of successful adoption of a structured handoff process. Future quality improvement studies addressing sustainability and widespread adoption of this approach appear to be warranted, and should include the relationships to improved care coordination and reduced preventable medical errors.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Unidades de Cuidados Coronarianos/organização & administração , Ciência da Implementação , Equipe de Assistência ao Paciente/normas , Transferência da Responsabilidade pelo Paciente/organização & administração , Melhoria de Qualidade , Idoso , Feminino , Seguimentos , Humanos , Masculino , Salas Cirúrgicas/normas , Transferência de Pacientes/métodos , Estudos Retrospectivos
11.
Br J Gen Pract ; 70(690): e9-e19, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31848201

RESUMO

BACKGROUND: Transitions between healthcare settings are vulnerable points for patients. AIM: To identify key threats to safe patient transitions from hospital to primary care settings. DESIGN AND SETTING: Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England. METHOD: Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3: 'not important', 4-6: 'somewhat important', 7-9: 'very important'). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%. RESULTS: A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. 'Poor quality of handover instructions from secondary to primary care teams' achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a 'very important' threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients. CONCLUSION: This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde para Idosos/organização & administração , Alta do Paciente/tendências , Transferência da Responsabilidade pelo Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Criança , Consenso , Técnica Delfos , Feminino , Idoso Fragilizado , Pessoal de Saúde , Humanos , Londres/epidemiologia , Masculino , Alta do Paciente/normas , Transferência da Responsabilidade pelo Paciente/normas , Segurança do Paciente
12.
BMJ Open Qual ; 8(4): e000630, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31799446

RESUMO

A lack of integration between internal processes and failure to use the full potential of information technology (IT) systems is common in psychiatric hospitals. We aimed to reduce the number of out-of-hours medical errors by ensuring that there is consistent and transparent weekend medical handover by creating an electronic handover system that is easy to use, robust and embedded into the existing trust IT systems. We employed quality improvement (QI) methodology to address this issue. After trialling in a single site followed by six cycles of improvement, the weekend medical handover system is now in use across four boroughs and has been integrated into trust policy. It has received qualitative and quantitative evidence of improvement, with 100% of doctors reporting the system improved patient care and a 64% (from 11 to 4 events/year) reduction in moderate, severe and catastrophic adverse incidents occurring out-of-hours within the older adult service (p=0.29, χ2 1.117). The increasing number of complex patients with comorbid medical illness in psychiatric inpatient services demands robust handover systems similar to that of an acute trust. This QI work offers a template for achieving this across other psychiatric trusts and demonstrates the positive change that can be achieved.


Assuntos
Continuidade da Assistência ao Paciente/normas , Registros Eletrônicos de Saúde/normas , Hospitais Psiquiátricos/organização & administração , Transferência da Responsabilidade pelo Paciente , Melhoria de Qualidade , Idoso , Comunicação , Humanos , Erros Médicos/prevenção & controle , Transferência da Responsabilidade pelo Paciente/organização & administração , Transferência da Responsabilidade pelo Paciente/normas , Segurança do Paciente , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/normas , Estudos Retrospectivos , Reino Unido
13.
BMJ Open ; 9(12): e032189, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31826892

RESUMO

OBJECTIVES: To investigate residents' and relatives' views and experiences of handovers in care homes. This paper reports residents' and relatives' awareness of handovers, knowledge of and views on handover practices and purpose, and views on handover effectiveness. Outcomes, safety and satisfaction in clinical settings are influenced by shift handovers. Despite this link with quality, residents' increasing support needs and the provision of 24 hours care in care homes for older people, little is known about handovers in these settings from a resident and visiting relative perspective. SETTING: Five purposively sampled care homes for older people in South East England. PARTICIPANTS: Home managers (n=5), residents (n=16) relatives of residents (n=10) were interviewed; residents (n=15) and their interactions with staff were observed during handover periods. Participation was voluntary and subject to consent. Residents were identified by managers as having mental capacity to take a decision about participation which was then assessed. An ethnographic approach to data collection was taken, preceded by an evidence review. RESULTS: Shift handovers were largely invisible processes to participating residents and relatives, many of whom had given little thought to handover practice, logistics or effectiveness prior to study participation. Their awareness and understanding of handovers, handover practices, and handover purpose and effectiveness varied. There appeared to be an underlying assumption that administrative procedures in care homes would operate without input from residents or relatives. A small number of residents, however, were highly aware of the routine of handovers and the implications of this for the timing of and response to their requests for care or support. CONCLUSIONS: The care home setting and perspectives of the effectiveness of handovers may influence awareness of, knowledge of and levels of interest in involvement in handovers.


Assuntos
Família/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Casas de Saúde/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Antropologia Cultural , Tomada de Decisões , Inglaterra , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa
14.
BMJ Open ; 9(11): e031245, 2019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31722944

RESUMO

INTRODUCTION: Hospital stays are critical events as they often disrupt continuity of care. This process evaluation aims to describe and explore the implementation of the VESPEERA programme (Improving continuity of patient care across sectors: An admission and discharge model in general practices and hospitals, Versorgungskontinuitaet sichern: Patientenorientiertes Einweisungs- und Entlassmanagement in Hausarztpraxen und Krankenhauesern). The evaluation concerns the intervention fidelity, reach in targeted populations, perceived effects, working mechanisms, feasibility, determinants for implementation, including contextual factors, and associations with the outcomes evaluation. The aim of the VESPEERA programme is the development, implementation and evaluation of a structured admission and discharge programme in general practices and hospitals. METHODS AND ANALYSIS: The process evaluation is linked to the VESPEERA outcomes evaluation, which has a quasi-experimental multi-centre design with four study arms and is conducted in hospitals and general practices in Germany. The VESPEERA programme comprises several components: an assessment before admission, an admission letter, a telephonic discharge conversation between hospital and general practice before discharge, discharge information for patients, structured planning of follow-up care after discharge in the general practice and a telephone monitoring for patients with a risk of rehospitalisation. The process evaluation has a mixed-methods design, incorporating interviews (patients, both care providers who do and do not participate in the VESPEERA programme, total n=75), questionnaires (patients and care providers who participate in the VESPEERA programme, total n=475), implementation plans of hospitals, data documented in general practices, claims-based data and hospital process data. Data analysis is descriptive and explorative. Qualitative data will be transcribed and analysed using framework analysis based on the Consolidated Framework for Implementation Research. Associations between the outcomes of the program and measures in the process evaluation will be explored in regression models. ETHICS AND DISSEMINATION: Ethics approval has been obtained by the ethics committee of the Medical Faculty Heidelberg prior to the start of the study (S-352/2018). Results will be disseminated through a final report to the funding agency, articles in peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: http://www.drks.de/DRKS00015183. TRIAL STATUS: The study protocol on hand is the protocol V.1.1 from 18 June 2018. Recruitment for interviews started on 3 September 2018 and will approximately be completed by the end of May 2019.


Assuntos
Assistência ao Convalescente/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Medicina Geral/organização & administração , Hospitalização , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Assistência Ambulatorial , Alemanha , Humanos , Transferência da Responsabilidade pelo Paciente/organização & administração , Pesquisa Qualitativa , Melhoria de Qualidade , Telefone
15.
Orv Hetil ; 160(44): 1735-1743, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31657253

RESUMO

Introduction: The most common reason for the adverse events in healthcare is communication. Due to the development of health technologies and the increasing specialization of care, more and more healthcare professionals are involved in the treatment of patients, resulting in an increasingly important role and risk for patient handover. Aim: To present the current state of knowledge of patient handover through the results of an international project. Method: Self-developed, anonymous questionnaires with single and multiple choice questions were used to investigate handover knowledge among healthcare workers in 3 Hungarian and 3 Polish hospitals. The frequency of responses was analyzed according to their correctness. The factors that can influence the knowledge were studied using a regression model in the Hungarian sample. Results: The questionnaire was completed by 63% of the 2963 employees who received the questionnaires. In the two countries, there was no significant difference in the proportion of correct responses. Nearly half of the responders (49.4%-45.7%) gave the right answers to the question about the definition of patient handover. The lowest rate of correct answers (14.4%-11.1%) was given to elements of patient handover techniques. The difficulty of the questions also showed a similar pattern. Conclusion: Based on the results, it can be concluded that knowledge of handover needs to be improved in both countries. Although healthcare providers have some knowledge about handover, it cannot be considered accurate and complete. It is important to promote the knowledge and practice of handover together for the safety of patients and healthcare providers. Orv Hetil. 2019; 160(44): 1735-1743.


Assuntos
Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Transferência da Responsabilidade pelo Paciente/organização & administração , Assistência Centrada no Paciente/métodos , Atitude do Pessoal de Saúde , Humanos , Hungria , Polônia , Inquéritos e Questionários
16.
Medicine (Baltimore) ; 98(40): e17459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577774

RESUMO

To determine the impact of the implementation of a hand-off bundle on medical errors at an inpatient unit of an academic community teaching hospital. Our secondary objective was to determine the research utility of the use of an all-electronic data collection system for medical errors.A retrospective review was conducted of 1290 admissions 6 months before and after implementation of an improved computerized hand-off tool and training bundle. The study took place at an academic community teaching hospital on a Family Medicine inpatient service caring for patients of all ages. The comparison focused on preventable and non-preventable adverse events.A significant decrease in medical errors was noted. Medical error rate dropped from 6.0 (95% CI, 4.2-8.3) to 2.2 (95% CI, 1.2-3.7) per 100 admissions (P < .001). Preventable medical errors dropped from 0.65 (95% CI, 0.18-1.67) to 0.15 (95% CI, 0.03-0.82) per 100 admissions (P = .194). Non-intercepted potential adverse events dropped from 1.30 (95% CI, 0.56-2.57) to 0.44 (95% CI, 0.09-1.30) per 100 admissions (P = .131). Intercepted potential adverse events dropped from 0.98 (95% CI 0.36-2.13) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .766) and errors with little potential for harm dropped from 2.77 (95% CI 1.61-4.43) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .009).Implementation of a standardized hand-off bundle was associated with a reduction in medical errors despite a low overall event rate. Further studies are warranted to determine the generalizability of this finding, to examine the overall epidemiology of medical errors and the reporting of such events within general medical teaching units.


Assuntos
Medicina de Família e Comunidade , Internato e Residência , Erros Médicos/prevenção & controle , Pacotes de Assistência ao Paciente , Transferência da Responsabilidade pelo Paciente/organização & administração , Centros Médicos Acadêmicos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos
17.
J Hosp Med ; 14(10): 622-625, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31433779

RESUMO

Appropriate calibration of clinical reasoning is critical to becoming a competent physician. Lack of follow-up after transitions of care can present a barrier to calibration. This study aimed to implement structured feedback about clinical reasoning for residents performing overnight admissions, measure the frequency of diagnostic changes, and determine how feedback impacts learners' self-efficacy. Trainees shared feedback via a structured form within their electronic health record's secure messaging system. Forms were analyzed for diagnostic changes. Surveys evaluated comfort with sharing feedback, self-efficacy in identifying and mitigating cognitive biases' negative effects, and perceived educational value of night admissions-all of which improved after implementation. Analysis of 544 forms revealed a 43.7% diagnostic change rate spanning the transition from night-shift to day-shift providers; of the changes made, 29% (12.7% of cases overall) were major changes. This study suggests that structured feedback on clinical reasoning for overnight admissions is a promising approach to improve residents' diagnostic calibration, particularly given how often diagnostic changes occur.


Assuntos
Tomada de Decisão Clínica , Medicina Interna/educação , Internato e Residência/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Atitude do Pessoal de Saúde , Competência Clínica , Erros de Diagnóstico/prevenção & controle , Retroalimentação , Humanos , Transferência da Responsabilidade pelo Paciente/normas , Estudos Prospectivos , Autoeficácia
18.
JBI Database System Rev Implement Rep ; 17(11): 2401-2414, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31425364

RESUMO

OBJECTIVES: The aim of this project was to improve the postoperative handover practice within the local context of an orthopedic surgical setting by implementing best practice. INTRODUCTION: Clinical handover is a communicative process where the responsibility of patient care is transferred through the exchange of patient information between the care providers. Postoperative handover is an important phase of perioperative care that presents challenges to handover personnel due to transitions in care throughout the perioperative period and the inability of surgical patients to participate in their own care. This paper reports on the best practice implementation project conducted in the field of postoperative handover among nurses in a 500-bed orthopedic surgical setting in Myanmar in 2017. METHODS: The project used the JBI Practical Application of Clinical Evidence System and the Getting Research into Practice audit tool to conduct a baseline audit and two follow-up audits. A total of 120 postoperative handovers were observed and data were collected. Education sessions and a series of discussion and engagement efforts were employed to increase the compliance with evidence-based postoperative handover practice. RESULTS: Baseline audit showed low compliance in audit criteria 3, 5 and 6, whereas varying compliance was observed in criteria 1, 2 and 4. Improvement was seen with five criteria in follow-up audits except for criterion 1. Compliance with criterion 1 was inconclusive because staff attendance at postoperative handovers varied, depending on patients' different handover needs. Nurses attendance, however, improved through engagement efforts and education sessions. CONCLUSION: We were able to make significant improvements in the underperforming areas related to postoperative patient handover. This project confirms that an SBAR (Situation, Background, Assessment, Recommendation) checklist has been implemented to navigate and document every postoperative handover at the main operating theater; the handover process at the intensive care unit complies with the COLD (Connect, Observe, Listen, Delegate) process; and attendance of handovers by nurses has increased. It is recommended that regular audits be conducted to sustain the change and improve where required.


Assuntos
Continuidade da Assistência ao Paciente/normas , Prática Clínica Baseada em Evidências/normas , Recursos Humanos de Enfermagem no Hospital/educação , Procedimentos Ortopédicos , Transferência da Responsabilidade pelo Paciente/normas , Período Pós-Operatório , Lista de Checagem , Humanos , Unidades de Terapia Intensiva , Mianmar , Recursos Humanos de Enfermagem no Hospital/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração
19.
Enferm Clin ; 29 Suppl 2: 439-444, 2019 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31281002

RESUMO

OBJECTIVE: This study examined the relationship of nurses' caring behavior with the implementation of bedside handover between shifts. METHODS: A descriptive cross-sectional design was used in this study. A total of 153 nurses in three hospitals in Kepulauan Bangka Belitung Province, Indonesia took part in the study and filled out the Handover Evaluation Scale (HES) and Measuring of Nurses' Caring Behavior (MNCB) questionnaires. Data were analyzed by performing Pearson correlation test. RESULTS: There was a statistically significant relationship between the nurses' caring behavior and bedside handover implementation (p=0.000, r=0.537). CONCLUSION: Nurses' caring behavior is linked with the implementation of the bedside handover. Nurse managers are expected to improve the caring behavior of nurses and the implementation of bedside handovers by designing a supportive environment, providing periodic supervision, and conducting the evaluation.


Assuntos
Empatia , Recursos Humanos de Enfermagem no Hospital/psicologia , Transferência da Responsabilidade pelo Paciente/organização & administração , Adulto , Estudos Transversais , Escolaridade , Humanos , Estado Civil
20.
J Subst Abuse Treat ; 102: 47-52, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31202288

RESUMO

BACKGROUND: In order to streamline the emergency department (ED) referral process in a multi-network automated opioid treatment referral program, we performed a needs assessment of community providers for Medication for Opioid Use Disorder (MOUD) in the EMergency department-initiated BuprenorphinE for opioid use Disorder (EMBED) trial network. METHODS: A needs assessment was conducted in two phases: (1) key stakeholder meetings and (2) a survey of community sites offering MOUD. Stakeholder meetings were conducted with five key stakeholder groups: 1) ED clinicians and staff, 2) community sites offering MOUD, 3) the investigative team, 4) health system IT staff, and 5) medical ethics experts. Meetings continued until each stakeholder group stated that their priorities and needs were understood. Major categories of needs were extracted pragmatically based on recurrence across stakeholder groups. Informed by needs expressed by IT and MOUD site stakeholders, nineteen MOUD sites were surveyed to better characterize information needs of community sites offering MOUD when receiving an ED referral. RESULTS: Three major categories of needs for referral system were identified: 1) The system to be automated, flexible and allow multiple channels of referral, 2) Referral metrics are retrievable in a HIPAA compliant manner, 3) Patients are scheduled into community sites offering MOUD as urgently as possible. Of the MOUD sites surveyed, 68.4% (13/19) responded. Based on the responses, specific patient identifiers were required for most MOUD site referrals, and encrypted emails and EHR were the preferred methods of communication for the handoff. 53.8% (7/13) of the sites were able to accept patients within 3 days with only 1 site requiring >7 days. CONCLUSION: These findings can inform IT solutions to address the discordant priorities of the ED (rapid and flexible referral process) and the community sites offering (referrals minimize variability and overbooking). To prevent drop-out in the referral cascade, our findings emphasize the need for increased availability and accessibility to MOUD on demand and protected communication channels between EDs and community providers of MOUD.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Transtornos Relacionados ao Uso de Opioides/reabilitação , Transferência da Responsabilidade pelo Paciente/organização & administração , Encaminhamento e Consulta/organização & administração , Automação , Buprenorfina/administração & dosagem , Comunicação , Serviço Hospitalar de Emergência/organização & administração , Humanos , Determinação de Necessidades de Cuidados de Saúde , Tratamento de Substituição de Opiáceos/métodos , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA