The portfolio effect: an opportunity for improving handoffs quality in ICU.

Autor: Monard C; Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. celine.monard@chu-lyon.fr.; PI3 (Pathophysiology of Injury-Induced Immunosuppression), Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Biomérieux, Lyon, EA, 7426, France. celine.monard@chu-lyon.fr., Carrere J; Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France., Abraham P; Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France., Cerro V; Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France., Polazzi S; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.; Health Data Department, Hospices Civils de Lyon, Lyon, France., Payet C; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.; Health Data Department, Hospices Civils de Lyon, Lyon, France., Rimmelé T; Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.; PI3 (Pathophysiology of Injury-Induced Immunosuppression), Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Biomérieux, Lyon, EA, 7426, France., Duclos A; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.; Health Data Department, Hospices Civils de Lyon, Lyon, France.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2024 Dec 04; Vol. 24 (1), pp. 1544. Date of Electronic Publication: 2024 Dec 04.
DOI: 10.1186/s12913-024-12007-7
Abstrakt: Background: Handoffs are a major determinant of patient's safety but their implementation remains heterogeneous and non-standardized. Organizational factors, including the order in which individual cases are handled within the handoff, may play a role in their quality. We aimed to confirm the existence of the portfolio effect (e.g. a decrease in duration allocated to individual cases as the global handoff progresses) in ICU's morning medical handoffs.
Methods: Two research assistants observed the morning handoffs in two ICUs (ICU-1, a 20-bed trauma and surgical ICU and ICU-2 a 10-bed medical and surgical ICU) within a university hospital, over a 6-month period. They were trained to measure the duration of each case (i.e., the handoff of a single patient). Patients' socio-demographic and clinical data were extracted from electronic medical records. The effect of the case position within the global handoff on its duration was determined using a linear regression after log transformation of duration. The case position was categorized as either before or after the median position (first and second halves). Covariates clinically associated with handoff duration were included in the model (age, sex, Charlson comorbidities index, SAPS II score, number of organ supports, center (ICU-1 or ICU-2) and reason for admission).
Results: 2485 individual cases nested in 169 morning handoffs and related to 494 patients' stays were observed. The mean (± SD) duration of the morning handoff was 60 minutes (± 12.5) in ICU-1 and 35.2 minutes (± 10.6) in ICU-2 with a mean number of cases presented of 18.9 (± 1.3) and 9.3 (± 1.0) respectively. The mean (± SD) duration of a case was 175 seconds (± 108). Trauma stays, patients severity and comorbidities, and the number of organ supports were associated with longer case handoffs. Asjusting for these covariates, cases in the second half were shorter compared to cases in the first half (RR 0.65, 95%CI (0.51 - 0.80)).
Conclusions: We confirmed the existence of a portfolio effect within ICU handoffs, emphasizing that interventions targeting handoffs' improvement should focus on the content and the setting. We suggest avoiding the presentation of a same patient systematically at the end of the round.
Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Hospices Civils de Lyon (n°20–98). According to the French law, retrospective utilization of non-genetic health-related personal data was authorized if the patient (or its legal representative) had not expressed wishes of non-participating to clinical research. Due to the retrospective, non-interventional nature of the study, necessity of written informed consent was waived. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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