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Strukturierte Patientenübergabe in der perioperativen Medizin

Rationale und Umsetzung in der klinischen Praxis

Structured patient handovers in perioperative medicine

Rationale and implementation in clinical practice

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An Erratum to this article was published on 06 July 2017

Zusammenfassung

Patientenübergaben in allen Fachgebieten der Medizin variieren in der Art und in ihrem Ausmaß. Kommunikation kann unstrukturiert verlaufen und dann erheblich zu einem erhöhten Risiko für einen Zwischenfall beitragen. Es ist somit unverzichtbar, in allen Bereichen der Medizin strukturierte Übergabekonzepte zu etablieren. Die perioperative Medizin ist ein Hochrisikobereich, der aufgrund von organisatorischen Rahmenbedingungen und einer teilweise hohen Arbeitsbelastung besonders anfällig für Kommunikationsdefizite und -fehler ist. Die Weltgesundheitsorganisation (WHO) fordert bereits seit 2005 ein strukturiertes Übergabekonzept, das die Information eines Patienten in einer inhaltlich vollständigen und konsequent eingehaltenen Reihenfolge wiedergibt. Das SBAR-Konzept („situation, background, assessment, recommendation“) ist ein einfach anzuwendendes Kommunikationskonzept, das bei konsequenter Verwendung mit einer verbesserten Qualität der Übergabe assoziiert ist.

In diesem Übersichtsartikel werden einfache Hilfsmittel für eine klare und konsistente Kommunikation dargestellt. Sie sind essenziell für eine effektive Teamarbeit und die Gewährleistung der Patientensicherheit. Anhand des SBAR-Konzepts werden die Effektivität einer strukturierten Patientenübergabe sowie die Möglichkeiten der Implementierung in den klinischen Alltag und potenzielle Barrieren anhand der bisher erschienenen Literatur aufgearbeitet. Kommunikationsdefizite zwischen den Berufsgruppen können so schneller identifiziert und durch Einführung eines strukturierten Übergabekonzepts reduziert werden.

Abstract

Clear and consistent communication is pivotal for well-functioning teamwork, in operating theatres as well as intensive care units. However, patient handovers significantly vary between specialties and locations. If communication is not well structured, it might increase the risk for mishaps and malpractice. Therefore, implementing structured handover protocols is pivotal. The perioperative setting is a high-risk environment that is prone to communication failures due to operational design (frequent change of shift due to working time restrictions) and a high work load and multitasking (operating room management, short surgery times, concurrent emergencies). Hence teamwork in the operating room and intensive care unit requires clear and consistent communication. In the perioperative setting, the patient is transferred several times: from the ward to operating room, to recovery, intermediate care/intensive care unit and back to normal ward. This necessitates multiple handovers. Since 2005, the World Health Organization (WHO) requests a structured handover concept that processes all relevant information in a predefined order. The SBAR concept (situation, background, assessment, recommendation) is an intuitive communication concept that can improve quality of patient handovers. This underlines the clinical relevance of a structured handover concept that leads to improved outcomes for every patient.

In this review, basic measures for a clear and consistent communication are presented. These are pivotal for an effective teamwork and for ensuing patient safety. Furthermore, we will focus on possibilities to implement structured approaches but also on potential barriers of implementation. Communication failure among different health care providers can be identified more easily and hopefully can be eliminated.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität München, München, Deutschland

    M. J. Merkel,  V. von Dossow & B. Zwißler

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  2. V. von Dossow
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  3. B. Zwißler
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Correspondence to V. von Dossow.

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Interessenkonflikt

M. J. Merkel, V. von Dossow und B. Zwißler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s00101-017-0343-z zu finden.

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Merkel, M.J., von Dossow, V. & Zwißler, B. Strukturierte Patientenübergabe in der perioperativen Medizin. Anaesthesist 66, 396–403 (2017). https://doi.org/10.1007/s00101-017-0320-6

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