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利用电子工具改善团队合作和跨专业交流,以满足复杂住院患者的需求:一项混合方法研究。

Using an electronic tool to improve teamwork and interprofessional communication to meet the needs of complex hospitalized patients: A mixed methods study.

机构信息

Institute for Better Health and Program of Medicine, Trillium Health Partners, 100 Queensway West, Clinical Administrative Building, 6th floor, Mississauga, Ontario, L5B 1B8, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.

出版信息

Int J Med Inform. 2019 Jul;127:35-42. doi: 10.1016/j.ijmedinf.2019.04.010. Epub 2019 Apr 13.

Abstract

BACKGROUND

Teamwork and interprofessional communication are important in addressing the comprehensive care needs of complex hospitalized patients. The objective of this study is to evaluate the impact of an electronic interprofessional communication and collaboration platform on teamwork, communication, and adverse events in the hospital setting.

MATERIALS AND METHODS

In this mixed methods study, we used a quasi-experimental design in the quantitative component and deployed the electronic tool in a staged fashion to 2 hospital wards 3 months apart. We measured teamwork, communication, and adverse events with Relational Coordination survey, video recordings of team rounds, and retrospective chart review. We conducted qualitative semi-structured interviews with clinicians to understand the perceived impacts of the electronic tool and other contextual factors.

RESULTS

Teamwork sustainably improved (overall Relational Coordination score improved from 3.68 at baseline to 3.84 at three and six months after intervention, p = 0.03) on ward 1. A small change in face-to-face communication pattern during team rounds was observed (making plans increased from 22% to 24%, p = 0.004) at 3 months on ward 1 but was not sustained at 6 months. Teamwork and communication did not change after the intervention on ward 2. There was no meaningful change to adverse event rates on either ward. Clinicians reported generally positive views about the electronic tool's impact but described non-technology factors on each ward that affected teamwork and communication.

CONCLUSION

The impact of using an electronic tool to improve teamwork and communication in the hospital setting appears mixed, but can be positive in some settings. Improving teamwork and communication likely require both appropriate technology and addressing non-technology factors.

摘要

背景

团队合作和跨专业沟通对于满足复杂住院患者的综合护理需求至关重要。本研究旨在评估电子跨专业沟通和协作平台对医院环境中的团队合作、沟通和不良事件的影响。

材料和方法

在这项混合方法研究中,我们在定量部分使用了准实验设计,并在 3 个月的时间内分两个阶段将电子工具部署到 2 个病房。我们使用关系协调调查、团队查房的视频记录和回顾性图表审查来衡量团队合作、沟通和不良事件。我们对临床医生进行了半结构化的定性访谈,以了解电子工具的感知影响和其他背景因素。

结果

第 1 病房的团队合作可持续改善(整体关系协调评分从基线时的 3.68 提高到干预后 3 个月和 6 个月时的 3.84,p=0.03)。在第 1 病房的团队查房中观察到面对面沟通模式的小变化(制定计划的比例从 22%增加到 24%,p=0.004),但在 6 个月时没有持续。第 2 病房的团队合作和沟通在干预后没有变化。两个病房的不良事件发生率都没有明显变化。临床医生对电子工具的影响普遍持积极看法,但描述了每个病房影响团队合作和沟通的非技术因素。

结论

在医院环境中使用电子工具来改善团队合作和沟通的效果似乎参差不齐,但在某些情况下可能是积极的。改善团队合作和沟通可能既需要适当的技术,也需要解决非技术因素。

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