Development and Validation of a Tool to Evaluate Hand-off Quality

描述（由申请人提供）：提供者之间的患者护理转换频繁发生，需要提供者传输关键临床信息。如果在交接过程中遗漏或误解了信息，可能会对患者护理造成严重的临床后果。事实上，研究表明，交接往往是可变的，代表了安全的病人护理的主要差距。对于由住院医生照顾的病人来说，由于2003年7月实施了住院值班时间限制，增加了转院频率，因此沟通不良造成的危险可能会扩大。此外，很少有受训人员接受正式的交接培训。联合委员会目前要求各医院采用标准化的交互式方法进行通信交接。不幸的是，由于缺乏有效的，标准化的工具来评估移交质量，医院和教育工作者不能评估他们的移交是否符合这些标准。最近，医学研究所建议所有居民接受关于交接策略的正规教育。 了解最佳实践过程中的移交和移交质量的有效评估是必要的，原因有几个：通过评估和反馈，以改善临床实践，照亮在目前的做法不足的领域，并在这个时代的值班时间限制，以最大限度地提高病人的安全。在芝加哥大学和耶鲁大学，研究人员在描述交接质量、设计和实施新颖的课程以改善不同水平的受训者之间的交接教育方面具有丰富的经验，并阐明了患者护理结果与较差的交接质量之间的关系。因此，从我们在这一领域的初步工作和其他行业的相关实践中，我们的目标是开发和测试一个可推广的工具，以评估在临床环境中的交接。 该应用程序的目的是开发和验证一个简单，灵活，可靠，实时的观察工具，以评估交接的做法。切换CEX是一种基于纸张的工具，可用于评估切换通信的发送方或接收方。该工具基于先前验证的，广泛使用的实时教育评估工具（Mini-CEX）;已发表的专家意见;以及我们先前的研究。我们的工具结合了独特的基于角色的锚点，适用于广告商和接收者，涉及口头沟通，专业性和环境，通过初步工作和专家意见了解的交接域。医院学术人员和医院工作人员医生将使用交接CEX（临床评价练习）来评估可行性。我们还将通过使用标准化的，录像的移交情况下，描绘了不同水平的性能的移交情况下，评估结构效度和评分员间的可靠性的工具。交接CEX将为教育工作者提供一种创新的、必要的、有效的和可行的方法，用于培训卫生专业人员进行安全有效的交接。最后，移交CEX将是一个有用的工具，以帮助医院提高病人的安全。

DESCRIPTION (provided by applicant): Transitions of patient care among providers occur frequently and require providers to transmit critical clinical information. If information is omitted or misunderstood during a hand-off, serious clinical consequences may result for patient care. In fact, studies have shown that hand-offs are often variable and represent a major gap in safe patient care. For patients cared for by resident physicians, dangers posed by poor communication may be amplified since the implementation of resident duty hour restrictions in July 2003 has increased transfer frequency. In addition, few trainees receive formal training on hand-offs. The Joint Commission currently requires hospitals to implement a standardized, interactive approach to hand-off communications. Unfortunately, due to a lack of valid, standardized tools to evaluate hand-off quality, hospitals and educators can not assess whether their hand-offs meet these criteria. More recently, the Institute of Medicine has recommended that all residents receive formal education on handoff strategies. Understanding best practices during hand-offs and valid assessment of hand-off quality are needed for several reasons: to improve clinical practice through evaluation and feedback, to illuminate areas of deficiency in current practices and to maximize patient safety in this era of duty hour restrictions. At the University of Chicago and Yale, investigators have extensive experience in describing hand-off quality, designing and implementing novel curricula to improve hand-off education amongst varying levels of trainees and have elucidated the relationship between patient care outcomes and poor hand-off quality. Therefore, drawing from our preliminary work in this area, and relevant practices in other industries, we aim to develop and test a generalizable tool to evaluate hand-offs in clinical settings. The aim of this application is to develop and validate a simple, flexible, reliable, real-time observation tool to evaluate hand-off practices. The Hand-off CEX is a paper-based instrument that can be used to evaluate either the sender or the receiver of hand-off communication. This tool is based on a previously-validated, widely-used, real-time educational evaluation tool (the Mini-CEX); published expert opinion; and our prior research. Our tool incorporates unique role-based anchors for both senders and receivers that refer to verbal communication, professionalism and environment, hand-off domains informed by preliminary work and expert opinion. The Hand-off CEX (Clinical Evaluation Exercise) will be used by academic hospitalists and house staff physicians to assess feasibility. We will also assess the construct validity and inter-rater reliability of the tool through the use of standardized, videotaped hand-off scenarios depicting various levels of performance of a hand-off scenario. The Hand-off CEX will arm educators with an innovative, necessary, valid and feasible method for training health professionals to conduct safe and effective hand-offs. Finally, the Hand-off CEX will be a useful tool to assist hospitals in improving patient safety.