A Prospective, Randomized, Controlled Study Demonstrating a Novel, Effective Model of Transfer of Care between Physicians: The 5 Cs of Consultation
A Prospective, Randomized, Controlled Study Demonstrating a Novel, Effective Model of Transfer of Care between Physicians: The 5 Cs of Consultation
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DOI：
10.1111/j.1553-2712.2012.01412.x
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发表时间：
2012-08-01
影响因子：
4.4
通讯作者：
Schwartz, Alan
中科院分区：
文献类型：
--
作者：
Kessler, Chad S.;Afshar, Yalda;Schwartz, Alan
学术急诊医学学会2012; 19：968974（c）2012摘要目标：目的是评价急诊科（艾德）的标准化会诊模式，即会诊的5个C（联系、沟通、核心问题、协作和闭环），是否能提高医生在会诊期间传递适当信息和成功沟通的能力。方法：这是一项在芝加哥的大型学术性城市三级医疗中心进行的前瞻性随机研究。将43名急诊医学（EM）和EM/内科（EM/IM）住院医师随机分为两组，干预组和非结构化组，按研究生年（PGY）分层。干预组的参与者接受了关于咨询5C的互动教育课程，这是一种标准化的咨询模式。干预组和非结构化组根据预先测试的模拟患者病例，向标准化顾问打了两个模拟咨询电话。三名评估者，天真的咨询模式和盲目的组分配，单独评估录音的每个电话使用七个项目，五点的全球评级量表（GRS）。最后，主治外科医生和主治精神科医生各自使用单一的全球评级来评估各自的病例，以提供量表的有效性证据。结果：无论是PGY还是临床病例，接受5Cs模式培训的住院医师沟通效果明显改善。干预组的平均GRS评分显著高于非结构化组（4.1 vs. 3.5，F（1，39）= 33.5，p < 0.0001）。二次分析的记录表明，遇到更多的5C行为往往会收到更高的GRS分数。结论：标准化的教育模式提高了从ED咨询沟通的有效性。与未经培训的居民相比，与咨询的5C培训的居民取得更好的咨询评估。培训方案应考虑采用标准化的咨询模式。
ACADEMIC EMERGENCY MEDICINE 2012; 19:968974 (c) 2012 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to evaluate whether a standardized consultation model in the emergency department (ED), the 5 Cs of Consultation (Contact, Communicate, Core Question, Collaboration, and Closing the Loop), would improve physicians ability to relay appropriate information and communicate successfully during a consultation. Methods: This was a prospective, randomized study at a large, academic, urban, tertiary care medical center in Chicago. Forty-three emergency medicine (EM) and EM/internal medicine (EM/IM) residents were randomized into two groups, an intervention group and an unstructured group, stratified by postgraduate year (PGY). Intervention group participants received an interactive educational session on the 5 Cs of Consultation, a standardized consultation model. Intervention and unstructured groups placed two simulated consultation phone calls, based on pretested simulated patient cases, to a standardized consultant. Three raters, naive to the consultation model and blinded to group assignments, individually assessed recordings of each call using a seven-item, five-point global rating scale (GRS). Finally, an attending surgeon and an attending psychiatrist each rated respective cases using a single global rating to provide validity evidence for the scale. Results: Residents trained with the 5 Cs model communicated significantly better, regardless of PGY and clinical case. The intervention group had significantly higher mean GRS scores than the unstructured group (4.1 vs. 3.5, F(1,39) = 33.5, p < 0.0001). Secondary analysis of the recordings suggested that encounters with more 5 Cs behaviors tended to receive higher GRS scores. Conclusions: A standardized educational model increased the effectiveness of consultation communication from the ED. Residents trained with the 5 Cs of Consultation scored better on consultation assessments compared with untrained residents. Training programs should consider adopting standardized consultation models.