科研之友
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摘要
After technical errors, the most common cause of avoidable adverse events during inpatient surgical care is communication-related breakdowns. Lapses in communication have been associated with delays in care and increased patient morbidity. A previous study conducted at 4 academic medical centers examined surgical resident and attending surgeon communication practices and identified errors in communication for more than 30% of identified critical events. The data in that study also showed that residents and attending surgeons had not discussed the plan of care for 15% of randomly selected patients and that more than 20% of weekend patients had not been seen for more than 48 hours by an attending surgeon.
This nonrandomized study was designed to investigate whether development and implementation of an interventional policy in surgical departments would lead to improved resident-attending communication practices, increased frequency of attending-patient interactions, and reduced failures in communication associated with critical patient events. Communication practices were compared before and after implementation of the policy according to the following 3 measures: (1) transfer into the intensive unit; (2) unplanned intubation or ventilatory support; and (3) cardiac arrest, new arrhythmia, or hemodynamic instability. The results of intervention were examined for a 19-month period. Specific measures to reinforce use of the policies included a resident-pocket information card and periodic reminders. Medical charts and audit information of randomly selected surgical services and care units for surgical patients were reviewed; repeat audits were conducted.
Information on resident and attending surgeon communication practices for 211 critical events and 1360 patients were reviewed. After the policy was implemented, the proportion of critical events not conveyed by a resident to an attending surgeon decreased from 33% (26/80) to 2% (1/47), gaps in the frequency of reporting of patient status on weekends by the attending surgeon were virtually eliminated (P < 0.0001), and the percentage of patients not visited by an attending surgeon for more than 24 hours on a weekend decreased from 61% to 33% (P = 0.0002). Improvements in resident-attending communication led to changes in patient management in one third of cases.
These findings show that implementation of this policy significantly improved resident-attending communication practices, reduced the incidence of potentially harmful communication breakdowns, and led to changes in patient management in inpatient surgical care.
- 出版日期2011-9
