I-PASS-to-PICU 的开发与评估:标准电子模板,用于改善儿科重症监护室设施间转诊沟通

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES Joint Commission journal on quality and patient safety Pub Date : 2024-01-24 DOI:10.1016/j.jcjq.2024.01.010
Nehal R. Parikh DO (is Fellow Physician, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Leticia S. Francisco (is Pre-Med Student, College of Liberal Arts and Sciences, University of Iowa.), Shilpa C. Balikai DO (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Mitchell A. Luangrath MD (is Clinical Assistant Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Heather R. Elmore DNP, ARNP (is Pediatric Nurse Practitioner, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.), Jennifer Erdahl MSN, RN, CCRN-K (is Nurse Manager, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital.), Aditya Badheka MBBS, MS (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Madhuradhar Chegondi MBBS, MD (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Christopher P. Landrigan MD, MPH (is Chief, Division of General Pediatrics, Boston Children's Hospital, and Director, Sleep and Patient Safety Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital / Harvard Medical School, Boston.), Priyadarshini Pennathur PhD (is Associate Professor, Department of Industrial, Manufacturing, and Systems Engineering, University of Texas at El Paso.), Heather Schacht Reisinger PhD (is Associate Professor, Department of Internal Medicine, Carver College of Medicine, University of Iowa, and Core Investigator, Institute for Clinical and Translational Science, University of Iowa.), Christina L. Cifra MD, MS (is Assistant Professor, Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital / Harvard Medical School and Adjunct Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa. Please address correspondence to Christina L. Cifra)
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Elmore DNP, ARNP (is Pediatric Nurse Practitioner, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.),&nbsp;Jennifer Erdahl MSN, RN, CCRN-K (is Nurse Manager, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital.),&nbsp;Aditya Badheka MBBS, MS (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.),&nbsp;Madhuradhar Chegondi MBBS, MD (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.),&nbsp;Christopher P. 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引用次数: 0

摘要

背景在医院间转诊至更高一级医疗机构的过程中,沟通不畅可能会对重症患儿造成伤害。将循证交接干预措施应用于医院间转诊沟通可避免不良事件的发生。本项目旨在开发和评估一个标准电子转诊模板(I-PASS-to-PICU),以改善医院间儿科重症监护室(PICU)的转诊沟通。一个 PICU 核心利益相关者小组合作设计了一个电子健康记录(EHR)支持的临床记录模板,该模板采用了循证交接项目 I-PASS 的元素,以支持转诊临床医生和接收 PICU 医生之间的信息交流。I-PASS-to-PICU 是一种由接收方驱动的工具,由 PICU 医生在 PICU 转院呼叫过程中用来指导口头交流和电子文档记录。该模板经历了三个周期的反复评估和重新设计,包括对多学科 PICU 工作人员的个人和小组访谈、使用模拟和实际转诊电话进行的可用性测试,以及与 PICU 医生的汇报。时间限制和二手信息传播被认为是障碍。使用模拟和实际通话对六名接受治疗的 PICU 医生进行了可用性测试,结果显示经过验证的系统可用性量表(SUS)具有良好的可用性,平均得分为 77.5(标准偏差为 10.9)。研究人员表示,大多数字段都是相关的,模板使用起来也很可行。结论I-PASS-to-PICU 在技术上是可行、可用和相关的。作者计划进一步评估其在改善 PICU 实时实践中信息交流方面的有效性。
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Development and Evaluation of I-PASS-to-PICU: A Standard Electronic Template to Improve Referral Communication for Interfacility Transfers to the Pediatric ICU

Background

Miscommunication during interfacility handoffs to a higher level of care can harm critically ill children. Adapting evidence-based handoff interventions to interfacility referral communication may prevent adverse events. The objective of this project was to develop and evaluate a standard electronic referral template (I-PASS-to-PICU) to improve communication for interfacility pediatric ICU (PICU) transfers.

Methods

I-PASS-to-PICU was iteratively developed in a single PICU. A core PICU stakeholder group collaboratively designed an electronic health record (EHR)–supported clinical note template by adapting elements from I-PASS, an evidence-based handoff program, to support information exchange between referring clinicians and receiving PICU physicians. I-PASS-to-PICU is a receiver-driven tool used by PICU physicians to guide verbal communication and electronic documentation during PICU transfer calls. The template underwent three cycles of iterative evaluation and redesign informed by individual and group interviews of multidisciplinary PICU staff, usability testing using simulated and actual referral calls, and debriefing with PICU physicians.

Results

Individual and group interviews with 21 PICU staff members revealed that relevant, accurate, and concise information was needed for adequate admission preparedness. Time constraints and secondhand information transmission were identified as barriers. Usability testing with six receiving PICU physicians using simulated and actual calls revealed good usability on the validated System Usability Scale (SUS), with a mean score of 77.5 (standard deviation 10.9). Fellows indicated that most fields were relevant and that the template was feasible to use.

Conclusion

I-PASS-to-PICU was technically feasible, usable, and relevant. The authors plan to further evaluate its effectiveness in improving information exchange during real-time PICU practice.

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CiteScore
3.80
自引率
4.30%
发文量
116
审稿时长
49 days
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Table of Contents Editorial Board The Joint Commission Journal on Quality and Patient Safety 50th Anniversary Article Collections: Diagnostic Excellence Supporting Professionalism in a Crisis Requires Leadership and a Well-Developed Plan. Quality and Simulation Professionals Should Collaborate.
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