School of Communication, Western Michigan University, 1903 W. Michigan Ave., Kalamazoo, MI 49008-5318, USA.
Ann Emerg Med. 2010 Feb;55(2):161-70. doi: 10.1016/j.annemergmed.2009.09.021. Epub 2009 Nov 27.
We develop and evaluate the Handoff Communication Assessment, using actual handoffs of patient transfers from emergency department to inpatient care.
This was an observational qualitative study. We derived a Handoff Communication Assessment tool, using categories from discourse coding described in physician-patient communication, previous handoff research in medicine, health communication, and health systems engineering and pilot data from 3 physician-hospitalist handoffs. The resulting tool consists of 2 typologies, content and language form. We applied the tool to a convenience sample of 15 emergency physician-to-hospitalist handoffs occurring at a community teaching hospital. Using discourse analysis, we assigned utterances into categories and determined the frequency of utterances in each category and by physician role.
The tool contains 11 content categories reflecting topics of patient presentation, assessment, and professional environment and 11 language form categories representing information-seeking, information-giving, and information-verifying behaviors. The Handoff Communication Assessment showed good interrater reliability for content (kappa=0.71) and language form (kappa=0.84). We analyzed 742 utterances, which provided the following preliminary findings: emergency physicians talked more during handoffs (67.7% of all utterances) compared with hospitalists (32.3% of all utterances). Content focused on patient presentation (43.6%), professional environment (36%), and assessment (20.3%). Form was mostly information-giving (90.7%) with periodic information-seeking utterances (8.8%) and rarely information-verifying utterances (0.4%). Questions accounted for less than 10% of all utterances.
We were able to develop and use the Handoff Communication Assessment to analyze content and structure of handoff communication between emergency physicians and hospitalists at a single center. In this preliminary application of the tool, we found that emergency physician-to-hospitalist handoffs primarily consist of information giving and are not geared toward question-and-answer events. This critical exchange may benefit from ongoing analysis and reformulation.
我们开发并评估了交接沟通评估工具，该工具使用的是急诊病房向住院治疗交接的实际患者转接。
这是一项观察性定性研究。我们从医患沟通、医学中的先前交接研究、健康沟通和健康系统工程中描述的话语编码类别中得出了交接沟通评估工具，并使用来自 3 名医师-医院医师交接的试点数据对其进行了验证。该工具由 2 个类型学组成，内容和语言形式。我们将该工具应用于在社区教学医院进行的 15 例急诊医师到医院医师的转接的便利样本中。使用话语分析，我们将话语分类到各个类别，并确定了每个类别和医生角色的话语出现频率。
该工具包含 11 个内容类别，反映了患者表现、评估和专业环境的主题，以及 11 个语言形式类别，代表信息寻求、信息提供和信息验证行为。交接沟通评估在内容（kappa=0.71）和语言形式（kappa=0.84）方面具有良好的评分者间可靠性。我们分析了 742 个话语，得出了以下初步发现：与医院医师（所有话语的 32.3%）相比，急诊医师在转接过程中讲话更多（所有话语的 67.7%）。内容主要集中在患者表现（43.6%）、专业环境（36%）和评估（20.3%）。形式主要是信息提供（90.7%），定期的信息寻求话语（8.8%），很少有信息验证话语（0.4%）。问题占所有话语的不到 10%。
我们能够开发并使用交接沟通评估工具来分析急诊医师和医院医师在单一中心之间的交接沟通的内容和结构。在该工具的初步应用中，我们发现急诊医师到医院医师的转接主要由信息提供组成，而不是针对问答事件。这种关键的交流可能需要不断的分析和重新制定。
