Brown Oliver S, Toi Teri Hh, Barbosa Pedro R, Pookarnjanamorakot Patra, Trompeter Alex
Junior Orthopaedic Research Fellow, Department of Trauma and Orthopaedics, St George's Hospitals NHS Foundation Trust, London SW17 0QT.
FY2 Doctor, Department of Gastroenterology, Basildon and Thurrock University Hospital, Basildon.
Br J Hosp Med (Lond). 2019 Aug 2;80(8):472-475. doi: 10.12968/hmed.2019.80.8.472.
Effective communication on surgical ward rounds should clarify for patients their management plan and answer questions adequately. Pressures on time conspire against this interchange of information. A patient-centred surgical communication check sheet was devised to enable rapid two-way transfer of information between surgeon and patient.
A quality improvement project involved three cycles. Through the use of a patient survey, distributed following the daily ward round, areas for improvement in communication were highlighted in cycle one. The surgical communication check sheet was introduced in cycle two, and modified before cycle three following discussion with the orthopaedic department. The surgical communication check sheet was handed out to patients before the ward round, and its efficacy was measured by evaluating ward round communication using the survey as in cycle one.
Initial results showed a variable standard of communication, which improved following the introduction of the surgical communication check sheet in cycle two. In cycle three, 84.7% patients felt that the check sheet aided communication on the ward round. Measures of communication improved between cycles one and three: the percentage of patients with unanswered questions fell from 21.8% to 16.7%, the number of patients unsure why a test was done fell from 25.9% to 12.7%, and average understanding of the management plan rose from 64.7% to 83.3%.
The introduction of the surgical communication check sheet improved ward round communication, and was welcomed by almost 85% of patients. Accounts from patients indicate two benefits of the check sheet: the surgeon is immediately aware of a patient with questions or concerns, allowing these to be adequately addressed, and patients can formulate questions before the ward round which bolsters their confidence to ask them.
外科查房时的有效沟通应向患者阐明其治疗计划并充分解答疑问。时间压力不利于这种信息交流。设计了一份以患者为中心的外科沟通检查表，以实现外科医生与患者之间快速的双向信息传递。
一项质量改进项目包括三个周期。在第一个周期中，通过在每日查房后发放患者调查问卷，突出了沟通方面需要改进的领域。在第二个周期引入了外科沟通检查表，并在与骨科部门讨论后于第三个周期前进行了修改。在查房前将外科沟通检查表分发给患者，并像在第一个周期中那样通过评估查房沟通情况来衡量其效果。
初步结果显示沟通标准参差不齐，在第二个周期引入外科沟通检查表后有所改善。在第三个周期，84.7%的患者认为检查表有助于查房时的沟通。从第一个周期到第三个周期，沟通指标有所改善：未得到解答问题的患者比例从21.8%降至16.7%，不确定为何进行某项检查的患者数量从25.9%降至12.7%，对治疗计划的平均理解率从64.7%升至83.3%。
引入外科沟通检查表改善了查房沟通，并且受到了近85%患者的欢迎。患者的反馈表明检查表有两个好处：外科医生能立即知晓有疑问或担忧的患者，从而能充分解决这些问题，并且患者可以在查房前准备好问题，这增强了他们提问的信心。
