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医生住院患者交换-患者和医生结果:系统性审查
Joshua Allen-Dicker1,2, Matthew Kerwin3, Joseph S Wallins2
1Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York, USA.
Journal of hospital medicine
|December 29, 2024
概括
改善住院患者的移交显示出患者结局的混合结果. 综合教育和结构性干预似乎最有效,但需要更多的研究,特别是随机试验.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 患者安全研究 患者安全研究
- 医学沟通研究 医学沟通研究
背景情况:
- 之前的审查表明,从住院移交干预措施来看,患者结局的改善不一致.
- 本系统性审查侧重于旨在改善医生在住院护理期间交换沟通的干预措施的有效性.
研究的目的:
- 系统地审查和综合有关住院患者移交干预措施有效性的证据.
- 评估这些干预措施对患者临床结果,患者和医生经验以及成本/利用指标的影响.
主要方法:
- 我们对PubMed,Embase和Cochrane控制试验中央注册表进行了系统的搜索.
- 包括实验性/准实验性研究,报告客观的患者临床,体验性或成本/利用结果.
- 使用ROBINS-1和ROB-2工具评估了偏差风险.
主要成果:
- 在42项研究中,大多数是在学术中心与居民进行的;6项是随机对照试验.
- 教育 (52%) 和结构性 (43%) 干预措施是常见的;结合方法更频繁地显示出显著的改善.
- 在不良事件 (3/16),医疗错误 (3/7) 和停留时间 (3/7) 中注意到显著改善;死亡率没有显著改善 (0/4).
结论:
- 关于住院患者移交干预措施有效性的证据是混合的,有限的高质量随机试验.
- 未来的研究应该探索患者的体验和成本/利用结果,并包括医院医生.
- 结合教育和结构性干预措施可能会带来更大的好处.
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