Division of General Internal Medicine, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Gen Intern Med. 2019 Jul;34(7):1167-1173. doi: 10.1007/s11606-019-04951-6.
Despite the ever-expanding role that the patient experience plays in healthcare, effective strategies proven to increase patient satisfaction ratings remain scarce. At the University of Pittsburgh Medical Center, we identified patient-doctor and patient-nurse communication as an area for intervention to improve suboptimal patient satisfaction among medicine inpatients. We posited that the likely reasons for underperformance in this area were a lack of adequate training in bedside communication skills.
We developed and evaluated a curriculum for medicine residents and nurses focused on clear communication at the bedside. A total of 76 internal medicine residents and 85 medical service nurses participated in 2016. The curriculum utilized didactics, video demonstrations, and role play, and was evaluated using pre- and post-surveys of participants' health literacy knowledge, attitudes, and confidence. Communication skills were evaluated using pre- and post-direct observation at the bedside with a communication skills checklist. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were compared 3 months before and after the curriculum to assess changes in patient satisfaction.
Knowledge and attitudes improved significantly for both residents and nurses. Residents' and nurses' observed clinical communication skills improved significantly in most domains, and there was moderate increase in communication-specific HCAHPS scores.
A small investment of curricular time devoted to clear communication skills improved residents' and medical nurses' knowledge, attitudes, skills, and communication-specific HCAHPS scores. This curriculum, focused on improving bedside communication skills, could be implemented in a variety of settings to improve patient satisfaction and patient experience.
尽管患者体验在医疗保健中的作用不断扩大,但能够提高患者满意度评分的有效策略仍然稀缺。在匹兹堡大学医学中心,我们发现医患沟通和护患沟通是一个需要干预的领域,可以提高内科住院患者的满意度。我们推测,在这方面表现不佳的可能原因是缺乏床边沟通技巧的充分培训。
我们为内科住院医师和护士开发并评估了一个专注于床边清晰沟通的课程。共有 76 名内科住院医师和 85 名医疗服务护士于 2016 年参与了该课程。该课程利用讲座、视频演示和角色扮演进行教学,并通过参与者健康素养知识、态度和信心的预调查和后调查进行评估。沟通技巧使用床边直接观察和沟通技巧检查表进行评估。在课程实施前后 3 个月比较医院患者评估医疗保健提供者和系统(HCAHPS)评分,以评估患者满意度的变化。
住院医师和护士的知识和态度都有显著提高。住院医师和护士的临床沟通技能在大多数领域都有显著提高,沟通特定的 HCAHPS 评分也有适度提高。
投入少量课程时间专注于清晰的沟通技巧,可以提高住院医师和医疗护士的知识、态度、技能以及沟通特定的 HCAHPS 评分。这个专注于改善床边沟通技巧的课程可以在各种环境中实施,以提高患者满意度和患者体验。