Feraco Angela M, Starmer Amy J, Sectish Theodore C, Spector Nancy D, West Daniel C, Landrigan Christopher P
Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
Acad Pediatr. 2016 Aug;16(6):524-31. doi: 10.1016/j.acap.2016.04.002. Epub 2016 Apr 16.
In a pre-post design, prospectively audio recorded verbal patient handoffs conducted at Boston Children's Hospital before and after implementation of the RHB were rated using the VHAT, which was developed for this study (primary outcome). Using generalizability theory, we evaluated the reliability of VHAT scores.
Overall, VHAT scores increased after RHB implementation (mean 142 vs 191, possible score 0-500; P < .0001). When accounting for clustering according to resident physician, hospital unit, unit census, and patient complexity, implementation of the RHB was associated with a 63-point increase in VHAT score. Using generalizability theory, we determined that a resident's mean VHAT score on the basis of a handoff of 15 patients assessed by a single observer was sufficiently reliable for relative ranking decisions (ie, norm-based; generalizability coefficient, 0.81), whereas a VHAT score on the basis of a handoff of 21 patients would be sufficiently reliable for high-stakes, standard-based decisions (Phi, 0.80).
Verbal handoffs improved after implementation of a RHB, although gains were variable across the 2 clinical units. The VHAT shows promise as an assessment tool for resident handoff skills. If used for competency or entrustment decisions, a resident's mean VHAT score should be on the basis of observation of verbal handoff of ≥21 patients.
1）为言语交接班评估工具（VHAT）的使用建立效度证据并检验VHAT评分的可靠性，以及2）确定住院医师交接班综合方案（RHB）的实施是否与儿科住院医师言语患者交接班的改善相关。
采用前后对照设计，前瞻性地对波士顿儿童医院在实施RHB前后进行的言语患者交接班进行录音，使用为本研究开发的VHAT进行评分（主要结局）。我们运用概化理论评估VHAT评分的可靠性。
总体而言，实施RHB后VHAT评分有所提高（平均142分对191分，可能得分0 - 500分；P <.0001）。在考虑住院医师、医院科室、科室普查人数和患者复杂性的聚类因素后，RHB的实施与VHAT评分提高63分相关。运用概化理论，我们确定，基于由单一观察者评估的15名患者的交接班得出的住院医师平均VHAT评分对于相对排名决策（即基于常模；概化系数为0.81）具有足够的可靠性，而基于21名患者的交接班得出的VHAT评分对于高风险、基于标准的决策（Phi值为0.80）将具有足够的可靠性。
实施RHB后言语交接班有所改善，尽管两个临床科室的改善情况存在差异。VHAT作为住院医师交接班技能的评估工具显示出前景。如果用于能力或委托决策，住院医师的平均VHAT评分应基于对≥21名患者言语交接班的观察。
