Rates of Medical Errors and Preventable Adverse Events Among Hospitalized Children Following Implementation of a Resident Handoff Bundle

被引:215
作者
Starmer, Amy J. [1 ,2 ]
Sectish, Theodore C. [1 ]
Simon, Dennis W. [1 ,3 ]
Keohane, Carol [4 ,5 ]
McSweeney, Maireade E. [1 ]
Chung, Erica Y. [1 ,6 ]
Yoon, Catherine S. [4 ,5 ]
Lipsitz, Stuart R. [4 ,5 ]
Wassner, Ari J. [1 ]
Harper, Marvin B. [1 ]
Landrigan, Christopher P. [1 ,4 ,5 ]
机构
[1] Harvard Univ, Sch Med, Boston Childrens Hosp, Div Gen Pediat,Dept Med, Boston, MA 02115 USA
[2] Oregon Hlth & Sci Univ, Doernbecher Childrens Hosp, Portland, OR 97201 USA
[3] Univ Pittsburgh, Childrens Hosp Pittsburgh, Med Ctr, Pittsburgh, PA 15213 USA
[4] Harvard Univ, Sch Med, Brigham & Womens Hosp, Div Gen Internal Med, Boston, MA 02115 USA
[5] Harvard Univ, Sch Med, Brigham & Womens Hosp, Div Sleep Med, Boston, MA 02115 USA
[6] Brown Univ, Rhode Isl Hosp, Warren Alpert Med Sch, Providence, RI 02903 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2013年 / 310卷 / 21期
基金
美国国家卫生研究院; 美国医疗保健研究与质量局;
关键词
DRUG EVENTS; SIGN-OUT; PATIENT-CARE; HOUSE STAFF; HEALTH-CARE; CONTINUITY; SAFETY; INTERVENTION; EDUCATION; IMPACT;
D O I
10.1001/jama.2013.281961
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE Handoff miscommunications are a leading cause of medical errors. Studies comprehensively assessing handoff improvement programs are lacking. OBJECTIVE To determine whether introduction of a multifaceted handoff program was associated with reduced rates of medical errors and preventable adverse events, fewer omissions of key data in written handoffs, improved verbal handoffs, and changes in resident-physician workflow. DESIGN, SETTING, AND PARTICIPANTS Prospective intervention study of 1255 patient admissions (642 before and 613 after the intervention) involving 84 resident physicians (42 before and 42 after the intervention) from July-September 2009 and November 2009-January 2010 on 2 inpatient units at Boston Children's Hospital. INTERVENTIONS Resident handoff bundle, consisting of standardized communication and handoff training, a verbal mnemonic, and a new team handoff structure. On one unit, a computerized handoff tool linked to the electronic medical record was introduced. MAIN OUTCOMES AND MEASURES The primary outcomes were the rates of medical errors and preventable adverse events measured by daily systematic surveillance. The secondary outcomes were omissions in the printed handoff document and resident time-motion activity. RESULTS Medical errors decreased from 33.8 per 100 admissions (95% CI, 27.3-40.3) to 18.3 per 100 admissions (95% CI, 14.7-21.9; P < .001), and preventable adverse events decreased from 3.3 per 100 admissions (95% CI, 1.7-4.8) to 1.5 (95% CI, 0.51-2.4) per 100 admissions (P = .04) following the intervention. There were fewer omissions of key handoff elements on printed handoff documents, especially on the unit that received the computerized handoff tool (significant reductions of omissions in 11 of 14 categories with computerized tool; significant reductions in 2 of 14 categories without computerized tool). Physicians spent a greater percentage of time in a 24-hour period at the patient bedside after the intervention (8.3%; 95% CI 7.1%-9.8%) vs 10.6%(95% CI, 9.2%-12.2%; P = .03). The average duration of verbal handoffs per patient did not change. Verbal handoffs were more likely to occur in a quiet location (33.3%; 95% CI, 14.5%-52.2% vs 67.9%; 95% CI, 50.6%-85.2%; P = .03) and private location (50.0%; 95% CI, 30%-70% vs 85.7%; 95% CI, 72.8%-98.7%; P = .007) after the intervention. CONCLUSIONS AND RELEVANCE Implementation of a handoff bundle was associated with a significant reduction in medical errors and preventable adverse events among hospitalized children. Improvements in verbal and written handoff processes occurred, and resident workflow did not change adversely.
引用
收藏
页码:2262 / 2270
页数:9
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