Background

Clinical handover is an essential step in the surgical patient’s hospital journey, but one that is not without risk. Within cardiothoracic surgery, endeavours to protocolise post-operative handover from cardiac theatre to cardiac intensive care units have resulted in enhanced patient safety, but little to no effort has focused on the pre-operative setting and the dissemination of information throughout the surgical team.

Methods

We designed a pre-post study examining the quality of pre-operative cardiothoracic patient handovers before and after the introduction of an intra-departmentally designed “Cardiothoracic Clinical Handover Tool” based on the Royal College of Surgeons of England’s guidelines for “Safe Handover”.

Results

Forty clinical handovers were assessed in each arm of the study. Handover quality improved from a score of 63.75% to 88.57% (p = < 0.001). This prolonged handover duration from a mean of 72.1 to 102.4 seconds per case (p = 0.003). Interruptions occurred in 27.5% of pre- and 25% of post-intervention handovers. Interruptions resulted in increased handover duration in both pre- and post-intervention groups (114.6 vs 77.7 seconds, p = 0.012) and poorer quality handovers in the pre-intervention group (51.28% vs 68.42%, p = 0.03) but failed to impact handover quality in the post-intervention group (88.57% vs 88.57%, p = 1).

Conclusions

Clinical handover tools have the potential to enhance the quality of pre-operative handover and protect against poor handover practices such as interruptions, safe-guarding patient welfare. We provide the first cardiothoracic specific pre-operative handover tool based on the RCSE guidelines.

中文翻译：

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开发术前“心胸临床交接工具”的试点研究及其对交接质量的影响

背景

临床交接是手术患者住院过程中的重要一步，但并非没有风险。在心胸外科中，努力制定从心脏手术室到心脏重症监护病房的术后移交方案，从而提高了患者的安全性，但很少或根本没有关注术前设置和整个手术团队的信息传播。

方法

我们设计了一项术前术后研究，根据英国皇家外科医学院的“安全交接”指南，检查引入部门内设计的“心胸临床交接工具”之前和之后的术前心胸患者交接质量。

结果

该研究的每组均评估了四十次临床交接。移交质量从 63.75% 提高到 88.57% ( p  = < 0.001)。每个案例的切换持续时间从平均 72.1 秒延长至 102.4 秒 ( p  = 0.003)。干预前交接中出现中断的比例为 27.5%，干预后交接中出现中断的比例为 25%。中断导致干预前组和干预后组的交接时间延长（114.6 秒 vs 77.7 秒，p  = 0.012），并且干预前组的交接质量较差（51.28% vs 68.42%，p  = 0.03），但未能产生影响干预后组的交接质量（88.57% vs 88.57%，p  = 1）。

结论

临床交接工具有潜力提高术前交接的质量，防止中断等不良交接行为，保障患者福利。我们提供第一个基于 RCSE 指南的心胸特定术前切换工具。