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过渡频繁发生，要求提供者传输关键的临床信息。如果信息在交接过程中被遗漏或误解，可能会给患者护理带来严重的临床后果。事实上，研究表明，移交往往是可变的，代表着安全患者护理方面的一个重大差距。对于由驻院医生护理的患者，由于2003年7月实行驻院值班时间限制，增加了转院频率，沟通不畅带来的危险可能会扩大。此外，很少有受训人员接受关于交接的正式培训。联合委员会目前要求医院采用标准化、互动式的方式进行切换通信。不幸的是，由于缺乏有效的标准化工具来评估移交质量，医院和教育工作者无法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移交战略的正式教育。 了解交接过程中的最佳实践和有效的交接质量评估出于以下几个原因：通过评估和反馈改进临床实践，阐明当前实践中的不足之处，并在这个值班时间限制的时代最大限度地提高患者安全。在芝加哥大学和耶鲁大学，研究人员在描述移交质量、设计和实施新课程以改善不同水平受训者的移交教育方面拥有丰富的经验，并阐明了患者护理结果和糟糕的移交质量之间的关系。因此，借鉴我们在这一领域的初步工作，以及其他行业的相关实践，我们的目标是开发和测试一种可推广的工具来评估临床环境中的移交。 该应用程序的目的是开发和验证一种简单、灵活、可靠、实时的观察工具来评估移交实践。切换CEX是一种纸质工具，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)、发表的专家意见和我们先前的研究。我们的工具结合了发送者和接收者独特的基于角色的锚，这些锚指的是言语交流、专业精神和环境，以及由前期工作和专家意见提供信息的交接域。交接的CEX(临床评估练习)将由学术住院医生和内科医生使用，以评估可行性。我们还将通过使用标准化的、录像的移交情景来评估该工具的结构效度和评分员之间的可靠性，这些情景描述了移交情景的不同水平的表现。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来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，帮助医院改善患者的安全。

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.