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Pediatrics. 2010 Mar;125(3):491-6. doi: 10.1542/peds.2009-0351. Epub 2010 Feb 8.
Theories from the psychology of communication may be applicable in understanding why hand-off communication is inherently problematic. The purpose of this study was to assess whether postcall pediatric interns can correctly estimate the patient care information and rationale received by on-call interns during hand-off communication.
Pediatric interns at the University of Chicago were interviewed about the hand-off. Postcall interns were asked to predict what on-call interns would report as the important pieces of information communicated during the hand-off about each patient, with accompanying rationale. Postcall interns also guessed on-call interns' rating of how well the hand-offs went. Then, on-call interns were asked to list the most important pieces of information for each patient that postcall interns communicated during the hand-off, with accompanying rationale. On-call interns also rated how well the hand-offs went. Interns had access to written hand-offs during the interviews.
We conducted 52 interviews, which constituted 59% of eligible interviews. Seventy-two patients were discussed. The most important piece of information about a patient was not successfully communicated 60% of the time, despite the postcall intern's believing that it was communicated. Postcall and on-call interns did not agree on the rationales provided for 60% of items. In addition, an item was more likely to be effectively communicated when it was a to-do item (65%) or an item related to anticipatory guidance (69%) compared with a knowledge item (38%). Despite the lack of agreement on content and rationale of information communicated during hand-offs, peer ratings of hand-off quality were high.
Pediatric interns overestimated the effectiveness of their hand-off communication. Theories from communication psychology suggest that miscommunication is caused by egocentric thought processes and a tendency for the speaker to overestimate the receiver's understanding. This study demonstrates that systematic causes of miscommunication may play a role in hand-off quality.
来自沟通心理学的理论或许可以帮助我们理解为什么交接班沟通存在固有问题。本研究旨在评估在交接班沟通中，下一班的住院医师是否能够正确估计当班住院医师接收到的患者护理信息和推理。
芝加哥大学的儿科住院医师接受了交接班访谈。下一班住院医师被要求预测当班住院医师在交接班时报告的每个患者的重要沟通信息及其伴随的推理，同时猜测当班住院医师对交接班情况的评价。然后，要求当班住院医师列出每个患者的最重要信息，以及下一班住院医师在交接班时传达的信息及其伴随的推理，同时评价交接班情况。住院医师在访谈中可以查阅书面交接班记录。
我们共进行了 52 次访谈，占合格访谈的 59%。共讨论了 72 名患者。尽管下一班住院医师认为信息已传达，但仍有 60%的时间未能成功传达患者最重要的信息。下一班和当班住院医师对提供的推理有 60%的分歧。此外，与知识类项目（38%）相比，待办事项（65%）或与预期指导相关的项目（69%）更有可能被有效地传达。尽管对交接班沟通中信息的内容和推理缺乏共识，但对交接班质量的同行评价仍然很高。
儿科住院医师高估了他们交接班沟通的效果。沟通心理学理论表明，沟通失误是由自我中心思维过程和说话者高估接收者理解能力的倾向引起的。本研究表明，沟通失误的系统原因可能在交接班质量中起作用。
