背景:现有的移交通信工具往往缺乏明确的理论基础,有有限的心理测量证据,忽视了有效的沟通策略来增强诊断推理。这种监督变得至关重要,因为切换期间的通信故障已牵涉到不良的患者护理中。为了解决这些问题,我们开发了一种结构化的通信工具:背景,负责任的诊断,包括鉴别诊断,排除鉴别诊断,后续行动,和通信(简讯C)。它是由认知偏见理论提供的,显示其分数的可靠性和有效性的证据,并包括在医疗移交中主动发送和接收信息的策略。
方法:测试前测试后干预研究。
方法:一家三级医院的住院内科和骨科病房。
方法:向参加现场教育会议的内科和骨科教师和居民介绍了Brief-C工具,接下来是2周的时间,他们练习使用反馈。
方法:对临床交接进行了为期1周的前和后的音频记录,然后转录分析。来自内科和骨科手术的两名教职员工使用BRIEF-C框架对移交的记录进行了评分。两名评估者对时间段视而不见。
结果:主成分分析确定了BRIEF-C上的两个分量表:诊断临床推理和交流,具有较高的项目间一致性(克朗巴赫的α分别为0.82和0.99)。一个样本t检验表明诊断临床推理显着改善(预测:M=0.97,SD=0.50;后检验:M=1.31,SD=0.64;t(64)=4.26,p<0.05,中大科恩d=0.63)和沟通(预测:M=0.02,SD=0.16;后检验:M=0.48,Cohen=0.83);t(64)=大
结论:本研究证明了证据支持BRIEF-C评分的可靠性和有效性,作为移交期间共享的诊断性临床推理和沟通的良好指标。
BACKGROUND: Existing handover communication tools often lack a clear theoretical foundation, have limited psychometric evidence, and overlook effective communication strategies for enhancing diagnostic reasoning. This oversight becomes critical as communication breakdowns during handovers have been implicated in poor patient care. To address these issues, we developed a structured communication tool: Background, Responsible diagnosis, Included differential diagnosis, Excluded differential diagnosis, Follow-up, and Communication (BRIEF-C). It is informed by cognitive bias theory, shows evidence of reliability and validity of its scores, and includes strategies for actively sending and receiving information in medical handovers.
METHODS: A pre-test post-test intervention
study.
METHODS: Inpatient internal medicine and orthopaedic surgery units at one tertiary care hospital.
METHODS: The BRIEF-C tool was presented to internal medicine and orthopaedic surgery faculty and residents who participated in an in-person educational session, followed by a 2-week period where they practised using it with feedback.
METHODS: Clinical handovers were audiorecorded over 1 week for the pre- and again for the post-periods, then transcribed for analysis. Two faculty raters from internal medicine and orthopaedic surgery scored the transcripts of handovers using the BRIEF-C framework. The two raters were blinded to the time periods.
RESULTS: A principal component analysis identified two subscales on the BRIEF-C: diagnostic clinical reasoning and communication, with high interitem consistency (Cronbach\'s alpha of 0.82 and 0.99, respectively). One sample t-test indicated significant improvement in diagnostic clinical reasoning (pre-test: M=0.97, SD=0.50; post-test: M=1.31, SD=0.64; t(64)=4.26, p<0.05, medium to large Cohen\'s d=0.63) and communication (pre-test: M=0.02, SD=0.16; post-test: M=0.48, SD=0.83); t(64)=4.52, p<0.05, large Cohen\'s d=0.83).
CONCLUSIONS: This
study demonstrates evidence supporting the reliability and validity of scores on the BRIEF-C as good indicators of diagnostic clinical reasoning and communication shared during handovers.