Zackoff Matthew W, Graham Camille, Warrick Denise, Pulda Kathleen, Gosdin Craig, Simpson Blair, Marischen Jessica, Bunch Paul, Vossmeyer Michael, Mussman Grant M
Critical Care Medicine, Department of Pediatrics and
Divisions of General and Community Pediatrics.
Hosp Pediatr. 2018 Apr;8(4):220-226. doi: 10.1542/hpeds.2017-0119.
During hospital admission, communication between primary care physicians (PCPs) and hospital medicine (HM) physicians provides an opportunity for collaboration. Two-way communication facilitates collaboration by allowing the receiver to ask and respond to questions. At our institution, most HM-to-PCP communication occurred by telephone call after discharge. Our specific aim was to increase the percentage of patients for whom a telephone conversation occurred between HM and PCPs during hospital admission from 40% to >80%.
An improvement team that included PCPs and HM physicians redesigned the process for communication with PCPs to emphasize collaboration during hospitalization. Interventions were used to target key drivers of information transparency, PCP and HM provider buy-in, the value of early call initiation, process standardization, accommodating provider availability, and preoccupation with failure. We used improvement-science methods and run charts to measure our progress and attain our goal.
The median weekly percentage of patients with a phone call completed during hospitalization increased from 40% to 85% at the satellite campus and 40% to 80% at the main campus. In addition to the standardized use of a telephone operator system to route calls and follow-up on unplaced calls, critical interventions included feedback on PCP call preferences to providers and the provider script for calls.
PCPs and HM physicians applied quality-improvement methodology to ensure reliable HM-PCP communication during hospital admission. Interventions to facilitate communication between providers and learners (who may otherwise have limited interaction), such as the scripting of phone calls and feedback from PCPs to HM physicians, were important for success.
在患者住院期间，初级保健医生（PCP）与医院内科医生（HM）之间的沟通为合作提供了契机。双向沟通通过让接收方提问和回答问题来促进合作。在我们机构，大多数HM与PCP之间的沟通是在出院后通过电话进行的。我们的具体目标是将住院期间HM与PCP之间进行电话沟通的患者比例从40%提高到80%以上。
一个由PCP和HM医生组成的改进团队重新设计了与PCP沟通的流程，以强调住院期间的合作。采取干预措施以针对信息透明度、PCP和HM医护人员的支持、尽早发起电话沟通的价值、流程标准化、适应医护人员的可及性以及对失败的关注等关键驱动因素。我们运用改进科学方法和运行图来衡量进展并实现目标。
在卫星院区，住院期间完成电话沟通的患者每周中位数百分比从40%增至85%，在主院区则从40%增至80%。除了标准化使用电话接线员系统来转接电话和跟进未接通的电话外，关键干预措施还包括向医护人员反馈PCP的通话偏好以及通话的医护人员脚本。
PCP和HM医生应用质量改进方法来确保住院期间HM与PCP之间可靠的沟通。促进医护人员与学习者（否则他们之间的互动可能有限）之间沟通的干预措施，如电话脚本编写以及PCP向HM医生提供反馈，对取得成功很重要。
