急诊科到住院部护理过渡：关于交接失败、诊断惯性和患者安全的叙述性综述
Emergency Department to Inpatient Care Transition: A Narrative Review of Handover Failures, Diagnostic Momentum, and Patient Safety.
摘要(中文译文)
从急诊科（ED）到住院服务的医疗过渡是急性内科入院中高风险的临床边界。在这一过程中，患者、临床信息、诊断推理、治疗责任、待完成的检查和升级预案必须同步转移。当这一交接不完整时，患者可能面临结果遗漏、用药差异、责任归属不清、升级延迟和诊断惯性等风险，即急诊科的初步标签被后续团队未经充分再评估即予接受。本叙述性综述审视了急诊科至住院过渡期间的交接失败、诊断惯性和患者安全风险。本文还讨论了这些过渡在不同卫生系统结构中的差异，包括住院医师主导模式、急性内科接诊路径、顾问单元制系统、病房转运、高依赖病房（HDU）和重症监护环境。常见薄弱环节包括疾病严重程度、工作诊断、诊断不确定性、治疗反应、待检项目、用药风险和应急计划沟通不完整。结构化沟通工具如SBAR（情况、背景、评估、建议）和I-PASS（疾病严重程度、患者摘要、行动清单、态势感知与应急计划、接收方综合复述）在适应当地工作流程、辅以培训并与接收方确认相结合时，可能提高交接的可靠性。本综述提出了急性内科入院实用交接要素，强调疾病严重程度、关键鉴别诊断、待完成任务、用药核对、升级触发因素和明确的随访问责。急诊科至住院的过渡应被视为一项主动的患者安全干预措施，而非纯粹的患者行政转运。明确沟通不确定性、病情轨迹和责任归属，可能减少急性内科入院期间可预防的伤害。
Abstract
The transition of care from the emergency department (ED) to inpatient services is a high-risk clinical boundary in acute medical admissions. During this process, the patient, clinical information, diagnostic reasoning, therapeutic responsibility, pending investigations, and escalation plans must move together. When this transfer is incomplete, patients may be vulnerable to missed results, medication discrepancies, unclear ownership, delayed escalation, and diagnostic momentum, where a provisional ED label becomes accepted by subsequent teams without adequate reassessment. This narrative review examines handover failures, diagnostic momentum, and patient-safety risks during ED-to-inpatient care transitions. It also discusses how these transitions differ across health-system structures, including hospitalist-based models, acute medical take pathways, consultant-unit systems, ward transfers, high-dependency units (HDU), and intensive care settings. Common vulnerabilities include incomplete communication of illness severity, working diagnosis, diagnostic uncertainty, treatment response, pending tests, medication risks, and contingency plans. Structured communication tools such as SBAR (Situation, Background, Assessment, Recommendation) and I-PASS (Illness Severity, Patient Summary, Action List, Situation Awareness and Contingency Planning, Synthesis by Receiver) may improve reliability when adapted to local workflows, supported by training, and paired with receiver confirmation. The review proposes practical handover elements for acute medical admissions, emphasizing illness severity, key differentials, pending tasks, medication reconciliation, escalation triggers, and explicit accountability for follow-up. The ED-to-inpatient transition should be treated as an active patient-safety intervention rather than a purely administrative movement of the patient. Clear communication of uncertainty, trajectory, and responsibility may reduce preventable harm during acute medical admissions.
如何引用
AMA
Abhishek Hanumanpratap Singh Kshatri. Emergency Department to Inpatient Care Transition: A Narrative Review of Handover Failures, Diagnostic Momentum, and Patient Safety.. Cureus. 2026; doi:10.7759/cureus.109294.
APA
Abhishek Hanumanpratap Singh Kshatri (2026). Emergency Department to Inpatient Care Transition: A Narrative Review of Handover Failures, Diagnostic Momentum, and Patient Safety.. Cureus. https://doi.org/10.7759/cureus.109294
GB/T 7714
Abhishek Hanumanpratap Singh Kshatri. Emergency Department to Inpatient Care Transition: A Narrative Review of Handover Failures, Diagnostic Momentum, and Patient Safety.[J]. Cureus, 2026 doi:10.7759/cureus.109294.
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