Effect of patient-centred bedside rounds on hospitalised patients' decision control, activation and satisfaction with care
Effect of patient-centred bedside rounds on hospitalised patients' decision control, activation and satisfaction with care
复制标题
DOI：
10.1136/bmjqs-2015-004561
复制
发表时间：
2016-12-01
影响因子：
5.4
通讯作者：
Shah, Hiren M.
中科院分区：
文献类型：
--
作者：
O'Leary, Kevin J.;Killarney, Audrey;Shah, Hiren M.
重要性尽管已经推广了跨专业的床边查房，以加强对住院患者以患者为中心的护理，目的评价以病人为中心的床边查房（PCBR）对以病人为中心的护理措施的影响。在一家大型城市医院中教授住院医师服务单位。参与者住院的普通内科患者。干预我们在两个干预单位上组建了工作组，由专业人员和患者/家属组成，以确定PCBR的最佳时机、持续时间和形式。护士和住院医生四舍五入在PCBR一起使用的通信工具，提供一个框架进行讨论和单位领导人加入PCBR提供辅导在最初几周的implementation.Main成果使用患者访谈，我们评估首选和经验丰富的角色在医疗决策中使用的控制偏好量表，激活使用的简短形式的患者激活措施，和满意度。我们还比较了出院后患者满意度调查项目相关的团队合作，参与决策和整体护理。我们评估了护士，医生和先进的实践提供者（APP）的PCBR的看法，使用为这项研究开发的一项调查。结果总体而言，650例患者在住院期间进行了结构化面试：284人被排除在外，因为定向障碍，54人被排除在外，因为非英语语言，72人拒绝参加，4人退出研究后登记。236例患者（122例对照组和114例干预组）获得了访谈数据，493例患者（274例对照组和219例干预组）获得了出院后满意度调查数据。我们发现，患者对共同决策、激活或对护理的满意度的看法没有显著差异。基于是否进行了PCBR（即，符合方案）的分析结果相似。我们还发现出院后患者满意度项目没有差异。在控制患者特征和研究单位内患者聚集的多变量分析中，结果相似。大多数护士（78.6%），但只有大约一半的住院医师和APP认为PCBR改善了与患者的沟通（47.4%）。少数护士（46.4%）和医生和APP（36.8%）同意，PCBR提高了他们的workedyear.Conclusions工作日的效率，PCBR没有影响病人的看法，共同决策，激活或满意度与护理。需要进行更多的研究，以确定可以在医院环境中可靠实施的最佳方法，以改善以患者为中心的护理。
ImportanceThough interprofessional bedside rounds have been promoted to enhance patient-centred care for hospitalised patients, few studies have been conducted in adult hospital settings and evidence of impact is lacking.Objective To evaluate the effect of patient-centred bedside rounds (PCBRs) on measures of patient-centred care.Design and setting Cluster randomised controlled trial involving four similar non-teaching hospitalist service units in a large urban hospital.Participants Hospitalised general medical patients.Intervention We assembled working groups on two intervention units, consisting of professionals and patient/family members, to determine the optimal timing, duration and format for PCBR. Nurses and hospitalists rounded together in PCBR using a communication tool to provide a framework for discussion and unit leaders joined PCBR to provide coaching during initial weeks of implementation.Main outcomes Using patient interviews, we assessed preferred and experienced roles in medical decision-making using the Control Preferences Scale, activation using the Short Form of the Patient Activation Measure, and satisfaction. We also compared postdischarge patient satisfaction survey items related to teamwork, involvement in decisions and overall care. We assessed nurses', physicians' and advanced practice providers' (APP) perceptions of PCBR using a survey developed for this study.Results Overall, 650 patients were approached for structured interview during hospitalisation: 284 were excluded because of disorientation, 54 were excluded because of non-English language, 72 declined to participate and 4 withdrew from the study after enrolment. Interview data were available for 236 (122 control and 114 intervention unit) patients, and postdischarge satisfaction survey data were available for 493 (274 control and 219 intervention unit) patients. We found no significant differences in patients' perceptions of shared decision-making, activation or satisfaction with care. Results were similar in analyses based on whether PCBR had been performed (ie, per protocol). We also found no difference in postdischarge patient satisfaction items. Results were similar in multivariate analyses controlling for patient characteristics and clustering of patients within study units. A majority of nurses (78.6%), but only about half of hospitalist physicians and APPs felt that PCBR improved communication with patients (47.4%). A minority of nurses (46.4%) and physicians and APPs (36.8%) agreed that PCBR had improved the efficiency of their workday.Conclusions PCBR had no impact on patients' perceptions of shared decision-making, activation or satisfaction with care. Additional research is needed to identify optimal approaches that can be reliably implemented in hospital settings to improve patient-centred care.