Servicios personalizados
Inglés (pdf)
Articulo en XML
Referencias del artículo
Enviar articulo por email
Citado por SciELO 
Similares en
SciELO 
Permalink
Introduction
The World Health Organization stated in 2007 that the passing of patient-related information is intended to ensure continuity of care and safety in the transition between caregivers, caregivers and patient/family, shifts, wards and settings. This moment of exchange has now become an integral part of daily work, given the frequent need to exchange information both formally and informally even several times a day.1 It is a very important moment within the process of caring for a person; in fact, the exchange is both in terms of sharing information for the purpose of comparison and decision-making, and in terms of taking responsibility for the patient's care pathway and ensuring its continuation.2
The increase in adverse events and relational discomfort between health professionals and between health professionals and patients often seems to be due to poor communication and operational misunderstandings. The emerging communication problem seems to have several causes:3) increasing complexity of care, increase in co-morbidities of in-patients, increase in the number of competencies attributed to each professional (basic, transversal, high), number of professionals involved in the care pathway, need to respond to complexity both with a technical-procedural approach and with decisions based on confrontation, common sense and opinions of professionals.4) Differences in age and experience between practitioners, the use of different communication styles may lead to difficulties in the exchange of information. Finally, within each care setting, work processes, relationships between the various professions, communication barriers play a decisive role.
Poor and inaccurate handover is estimated to be responsible for 80 % of preventable serious adverse events.
The consequences in terms of harm to the patient, organisational malaise for staff, and costs for health care companies, have in recent years stimulated the analysis of 'patient care' activities, with the aim of investigating the criticalities that may arise and their causes, and the search for effective and efficient solutions.3)
The transfer of information between physiotherapists generally takes place in the event that the practitioner in charge of the physiotherapy programme needs to transfer responsibility for the continuation of that programme to a colleague. In the last decade, the planning of physiotherapy intervention, always strictly outcome-based, has undergone significant changes. Nowadays, the intervention of the physiotherapist is not limited to highly rehabilitative settings, but is also recommended in early or advanced phases of the patient's care process during which individual programmes are carried out in specialised but non-rehabilitative settings.
The handover can be transferred in different ways: verbal, written, at the patient's bedside. Typically, physiotherapists used verbal delivery supplemented by the paper documentation already in use and available for consultation at any time: the daily diary, the functional assessment, the team cards when present. In recent years, verbal delivery alone has proven insufficient to respond to the complexity of the organisation, often professionals do not meet in person, secondly, the amount of information is numerous; therefore, it is difficult to remember everything by heart and in particular to select the necessary information to be transferred. Written deliveries make it possible to quickly assess and redistribute the daily workload of the entire care unit in the event of organisational needs. In view of the emerging need to standardise handover between physiotherapists, an improvement project was set up in 2019 aimed at incorporating a flexible and standardised tool for the exchange of handovers in the Rehabilitation Operating Unit, which would be adapted to the different physiotherapy settings and programmes. In particular, inspiration was taken from the recent implementation in the Medical Area of the SBAR (acronym Situation, Background, Assessment, Raccomandation)5 method (implemented in 2018), also for the rehabilitation area, a standardised method that is effective in guaranteeing the correct exchange of information and consequently safety and continuity of care.
Metod SBAR
The methodology SBAR (acronym Situation, Background, Assessment, Raccomandation),6,7,8,9) problem-centred and not person-centred, it is the most widely used in healthcare today. The World Health Organization has given the method wide recognition by including it in 2009 as one of the Communications Tools for patient safety. It can be used in all settings, and although it is set up as written communication, it also lends itself to direct face-to-face and telephone communication. SBAR ensures that everyone has the same expectations of the content of the delivery by facilitating communication even between different professions. In particular, it ensures clarity about what will be communicated, how the information is classified and what information is needed.
Table 1 SBAR TOOL
| S | Situation | A concise statement of the problem | Problem Description |
| B | Background | Pertinent and brief information related to the situation | Relevant information with respect to history and situation |
| A | Assessment | Analysisi and cponsiderations of oprions - whatyoufind/think | Assessment of the problem by the professional |
| R | Recomendation | Action requested/reccomended - whatyouwant | Recommended actions |
The acronym identifies 4 columns whose contents, in order to convey an effective and safe delivery, must be developed according to a "horizontal" logic by problems, the current or proposed interventions must be inherent to specific problems, avoiding useless information concerning functional aspects for which there is no need to intervene (problems are described).
The literature suggests that this method is also adaptable to the rehabilitation field.6,7,10,11
This project was promoted by the Directorate DATeR of Bologna (Technical Assistance and Rehabilitation Management), has therefore addressed the profession of Physiotherapist in particular. The project started at the beginning of 2019.
Indicator 1 - Use of the board SBAR
Number of rehabilitation SBAR cards filled in/ number of deliveries made (target 80 %). Given the impossibility of identifying a specific moment for the hand over, and given the high number of filled in SBARs expected to be collected, a quantitative self-detection method was chosen by the professionals of the Operating Units. Each professional, for each moment of hand over (delivery in case of absence of the professional from the service, delivery for the Saturday shift), filled in:
the SBAR forms concerning the number of patient-cases-treatments to be transferred.
the weekly survey form of the number and type of deliveries made. For each hand-over time, the practitioner reported the number of patient-cases-treatment delivered to the colleague, the mode of delivery used (by SBAR, verbal, other) and the reason why a delivery other than SBAR was used.
Both the SBAR and the survey form were included in the 'deliveries'. In order to adapt to the different intervention settings, SBAR sheets were compiled and collected in folders grouped by work area and shared. On the other hand, the 'handover survey' form was only filled in on paper.
At the end of the month, the Business Unit working group collected the contents of the binder for the measurement of the indicator.
For the measurement of the indicator, it was defined a priori that each transferred case-patient-treatment corresponded to the filling in of one SBAR form, even though several case-patients may be present in one form.
Table 2 Indicator 1
| Unit care rehabilitation | Mode of transfer of handover | Total handover | |||
|---|---|---|---|---|---|
| SBAR | Other form handover | Other documents | Report | ||
| UA OB | 238 | / | 15 | 23 | 276 |
| UA OM | 569 | 23 | 45 | 53 | 690 |
| UA SGP | 179 | 3 | 25 | 23 | 230 |
| UA P-V | 132 | / | 18 | 34 | 184 |
| Total | 1118 | 26 | 103 | 133 | 1380 |
Legend: UA OB: Rehabilitation Care Unit Bellaria Hospital; UA OM: Rehabilitation Care Unit Maggiore Hospital; UA SGP: Rehabilitation Service Unit San Giovanni in Persiceto Hospital; AU P-V: Hospital and Territorial Rehabilitation Service Unit Porretta and Vergato
Indicator 2 - correct way of filling in the SBAR card
Number of completed cards adhering to the legend/number of completed cards sampled (target 80 %)
It was decided to carry out the verification of the correct filling in of the SBAR form on a sample of selected forms. Within each Operating Units, 1 SBAR form was selected each month for each area of physiotherapy intervention, when present. The correctness of the compilation was verified by checking the contents of the different columns I, S, B, A, R) (adherence to the legend). The forms containing at least one error were considered to be incorrect.
Table 3 Indicator 2
| Rehabilitation Care Unit | |||||
|---|---|---|---|---|---|
| UA OB | UA OM | UA SGP | UA P-V | ||
| Total areas of work | 7 | 7 | 5 | 6 | |
| Sampled SBAR cards | 42 | 42 | 30 | 36 | 150 |
| Correct cards | 28 | 24 | 24 | 32 | 108 |
| Incorrect cards | 14 | 18 | 6 | 4 | 42 |
Legend: UA OB: Rehabilitation Care Unit Bellaria Hospital; UA OM: Rehabilitation Care Unit Major Hospital; UA SGP: Rehabilitation Service Unit San Giovanni in Persiceto Hospital; UA P-V: Hospital and Territorial Rehabilitation Care Unit Porretta and Vergato.
The self-registration by the physiotherapists of the delivery methods they used was useful for the detection of the indicator but took up some of the time that would have been useful for practice with the SBAR. Some colleagues experienced this commitment with anxiety as an evaluation of the professionals' performance. It was noted by professionals that some paper SBARs were then not reported, losing some data. Similarly, some completed SBARs were lost because they were saved on computers but not in the appropriate folders. The difficulty of inserting a new tool was mainly due to the resistance of some who, from the outset, judged the SBAR form as inappropriate for delivery. In spite of the criticism, most of the colleagues involved showed a proactive approach to the tool, making interesting contributions both for the improvement of the scale and to better clarify certain points in collective meetings.
The need to synthesise the information for the hand-over according to a problem-based logic created difficulties for almost all physiotherapists, resulting in overly rich sheets of information often placed in the wrong box. Delivery according to the global patient care model remains in use by a minority of the colleagues involved, although the SBAR method has given rise to reflections. The change to a new delivery method with its tool stimulated individual professional reflection and virtuous discussion between professionals, but also resistance of individuals to the change and took a long time on the part of professionals. It might be useful to continue with the professional reflection and peer discussion by analysing in more detail:
