当前位置： SCI文献检索 > JOURNAL OF GENERAL INTERNAL MEDICINE期刊下所有文献 > Use of an appreciative inquiry approach to improve resident sign-out in an era of multiple shift changes.

Use of an appreciative inquiry approach to improve resident sign-out in an era of multiple shift changes.

Abstract：

BACKGROUND:Resident duty hour restrictions have resulted in more frequent patient care handoffs, increasing the need for improved quality of residents' sign-out process. OBJECTIVE:To characterize resident sign-out process and identify effective strategies for quality improvement. DESIGN:Mixed methods analysis of resident sign-out, including a survey of resident views, prospective observation and characterization of 64 consecutive sign-out sessions, and an appreciative-inquiry approach for quality improvement. PARTICIPANTS:Internal medicine residents (n = 89). INTERVENTIONS:An appreciative inquiry process identified five exemplar residents and their peers' effective sign-out strategies. MAIN MEASURES:Surveys were analyzed and observations of sign-out sessions were characterized for duration and content. Common effective strategies were identified from the five exemplar residents using an appreciative inquiry approach. KEY RESULTS:The survey identified wide variations in the methodology of sign-out. Few residents reported that laboratory tests (13%) or medications (16%) were frequently accurate. The duration of observed sign-outs averaged 134 ±73 s per patient for the day shift (6 p.m.) sign-out compared with 59 ± 41 s for the subsequent night shift (8 p.m.) sign-out for the same patients (p = 0.0002). Active problems (89% vs 98%, p = 0.013), treatment plans (52% vs 73%, p = 0.004), and laboratory test results (56% vs 80%, p = 0.002) were discussed less commonly during night compared with day sign-out. The five residents voted best at sign-out (mean vote 11 ± 1.6 vs 1.7 ± 2.3) identified strategies for sign-out: (1) discussing acutely ill patients first, (2) minimizing discussion on straightforward patients, (3) limiting plans to active issues, (4) using a systematic approach, and (5) limiting error-prone chart duplication. CONCLUSIONS:Resident views toward sign-out are diverse, and accuracy of written records may be limited. Consecutive sign-outs are associated with degradation of information. An appreciative-inquiry approach capitalizing on exemplar residents was effective at creating standards for sign-out.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Helms AS,Perez TE,Baltz J,Donowitz G,Hoke G,Bass EJ,Plews-Ogan ML

doi

10.1007/s11606-011-1885-4

subject

Has Abstract

pub_date

2012-03-01 00:00:00

pages

287-91

issue

eissn

0884-8734

issn

1525-1497

journal_volume

pub_type

杂志文章

在线工具

Use of an appreciative inquiry approach to improve resident sign-out in an era of multiple shift changes.