CONSULTATION IN THE EMERGENCY DEPARTMENT: A QUALITATIVE ANALYSIS AND REVIEW
CONSULTATION IN THE EMERGENCY DEPARTMENT: A QUALITATIVE ANALYSIS AND REVIEW
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DOI：
10.1016/j.jemermed.2011.01.025
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发表时间：
2012-06-01
影响因子：
1.5
通讯作者：
Badillo, Christian
中科院分区：
文献类型：
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作者：
Kessler, Chad;Kutka, Bradley M.;Badillo, Christian
背景：没有研究评估咨询过程或试图定义可以改善沟通和患者治疗结果的标准化方法。目的：对急诊医学（EM）咨询进行定性分析，以揭示其复杂性并阐明医生之间沟通的策略和框架。方法：数据分三个阶段收集：在急诊科 (ED) 进行非正式访谈、对一部分急诊科和专科医生进行 10 个问题的调查，以及使用开放式问题进行半结构化 1 小时小组访谈，以进一步探讨从调查答复中得出的问题和趋势。此外，我们还进行了广泛的文献检索，重点关注医疗保健和商业咨询与沟通。结果：76%（38 名急诊科医生和专科医生中的 29 名）完整完成了包含 10 个问题的调查。从调查答复中确定了三个主题：组织技能、人际和沟通技能以及医学知识。在 95 条评论中，41 条 (43%) 关注组织技能，26 条 (27%) 关注人际和沟通技巧，28 条 (30%) 关注医学知识。咨询质量不佳的评论共 29 条，其中组织问题 15 条，人际沟通能力问题 6 条，医学知识问题 8 条。文献检索揭示了几种咨询模型和类型，但目前尚不存在标准算法。结论：我们建议在急诊科教学时重点关注组织技能、人际和沟通技巧以及医学知识，并提出 5C 咨询模型的概念框架：联系；沟通、核心问题、协作和闭环。 (C) 2012 爱思唯尔公司。
Background: No studies have evaluated the consultation process or attempted to define a standardized approach that could improve communication and patient outcomes. Objective: To perform a qualitative analysis of emergency medicine (EM) consultation to reveal its complexity and elucidate strategies and frameworks for physician-to-physician communication. Methods: Data were collected in three phases: informal interviews conducted in an emergency department (ED), 10-question surveys given to a subset of EM and specialty physicians, and semi-structured 1-h group interviews using open-ended questions to further explore issues and trends elicited from the survey responses. In addition, we conducted an extensive literature search focused on health care and business consultation and communication. Results: Seventy-six percent (29 of 38) of emergency and specialty physicians completed the 10-question survey in its entirety. Three themes were identified from the survey responses: organizational skills, interpersonal and communication skills, and medical knowledge. Of 95 total comments, 41 (43%) focused on organizational skills, 26 (27%) on interpersonal and communication skills, and 28 (30%) on medical knowledge. There were 29 comments regarding poor consultations: 15 issues with organization, 6 with interpersonal and communication skills, and 8 with medical knowledge. The literature search revealed several models and types of consultation, but no standard algorithm currently exists. Conclusions: We recommend focusing on organizational skills, interpersonal and communication skills, and medical knowledge when teaching ED consultation and present a conceptual framework of the Five Cs Consultation Model: contact; communication, core question, collaboration, and closing the loop. (C) 2012 Elsevier Inc.