Considering Factors of and Knowledge About Patients in Handover Assessment.
Considering Factors of and Knowledge About Patients in Handover Assessment.
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在交接评估中考虑患者的因素和知识。
DOI：
10.1109/thms.2013.2274595
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发表时间：
2013
影响因子：
3.6
通讯作者：
Hoke,George
中科院分区：
文献类型：
--
作者：
Meth,Sharon;Bass,EllenJ;Hoke,George
医疗保健系统正在从一个负责每个病人的主治医生转向更以团队为基础的方法。因此，评估团队沟通至关重要。本研究使用文献推荐的内容和语言形式元素来表征和评估换班时医院医生交接沟通的质量。质量移交应包含以下内容：患者标识符、活动问题和护理计划。质量移交还应包括以下语言形式的话语：解释、理由和指示。采用访谈法、观察法、录音法和会话分析法对医院交接沟通进行分析。对医院交接话语进行内容编码和语言形式编码。计算所有病人移交过程中质量要素言语化的比例。此外，还考察了患者因素（新入院、新问题、急性程度）和接诊者知识对质量要素纳入的影响。记录了16次交接过程中106例个体患者的交接情况。39%包含所有六个质量要素。虽然大多数移交都包含六项质量要素中的五项，但只有48%的移交包含指令。在基于患者因素或交接接受者知识的质量要素纳入方面也没有差异。医院的交接缺乏指示。通过加强电子病历系统和培训来改善移交工作的努力可能需要扩大到医院医生和其他主治医生。
The healthcare system is moving from one primary physician who assumes responsibility for each patient to a more team-based approach. Thus, assessing team communication is critical. This study characterizes and assesses the quality of hospitalist handover communications at shift change using the literature recommended content and language form elements. Quality handovers should contain the following content: patient identifiers, active issues, and care plans. Quality handovers also should include utterances in the following language forms: explanations, rationales, and directives. Interviews, observation, recording, and conversation analysis of hospitalist handover communications were used. Hospitalist handover utterances were assigned both content and language form codes. The proportion of quality element verbalization across all patient handovers was calculated. In addition, the impact of patient factors (new admission, new problem, acuity level) and handover receiver knowledge on the inclusion of quality elements was examined. The 106 individual patient handovers across 16 handover sessions were recorded. 39% contained all six quality elements. While the majority of handovers contained five out of six quality elements, only 48% included directives. There was also no difference in the inclusion of quality elements based on patient factors or handover receiver knowledge. Hospitalist handovers are lacking in directives. Efforts to improve handovers through enhanced electronic medical record systems and training may need to expand to hospitalists and other attending level physicians.