Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California.
Pediatrics. 2021 May;147(5). doi: 10.1542/peds.2020-0681. Epub 2021 Apr 15.
To increase the number of essential consult elements (ECEs) included in initial inpatient consultation requests between pediatric residents and fellows through implementation of a novel consult communication tool.
Literature review and previous needs assessment of pediatric residents and fellows were used to identify 4 specific ECEs. From February to June 2018, fellows audited verbal consult requests at a medium-sized, quaternary care children's hospital to determine the baseline percentage of ECE components within consults. A novel consult communication tool containing all ECEs was then developed by using a modified situation-background-assessment-recommendation (SBAR) format. The SBAR tool was implemented over 3 plan-do-study-act cycles. Adherence to SBAR, inclusion of ECEs, and consult question clarity were tracked via audits of consult requests. A pre- and postintervention survey of residents and fellows was used to examine perceived miscommunication and patient care errors and overall satisfaction.
The median percentage of consults containing ≥3 ECEs increased from 50% preintervention to 100% postintervention with consult question clarity increasing from 52% to 92% ( < .001). Overall perception of consult miscommunication frequency decreased (52% vs 18%; < .01), although there was no significant change in resident- or fellow-reported patient errors. SBAR maintained residents' already high consult satisfaction (96% vs 92%; = .39) and increased fellows' consult satisfaction (51% vs 91%; < .001).
Implementation of a standardized consult communication tool resulted in increased inclusion of ECEs. Use of the tool led to greater consult question clarity, decreased perceived miscommunication, and improved overall consult satisfaction.
通过实施一种新的咨询沟通工具，增加儿科住院医师和研究员初始住院咨询请求中包含的基本咨询要素 (ECE) 的数量。
文献回顾和对儿科住院医师和研究员的前期需求评估用于确定 4 个特定的 ECE。2018 年 2 月至 6 月，研究员在一家中等规模的四级儿童保健医院对口头咨询请求进行审核，以确定咨询中 ECE 成分的基线百分比。然后，使用修改后的情景-背景-评估-建议 (SBAR) 格式开发了一种新的咨询沟通工具，其中包含所有 ECE。该 SBAR 工具在 3 个计划-执行-研究-行动循环中实施。通过审核咨询请求，跟踪 SBAR 的依从性、ECE 的纳入以及咨询问题的清晰度。对住院医师和研究员进行干预前后的调查，以检查感知的沟通错误和患者护理错误以及整体满意度。
含有≥3 个 ECE 的咨询的中位数百分比从干预前的 50%增加到干预后的 100%，咨询问题的清晰度从 52%增加到 92%（<0.001）。咨询沟通错误频率的总体感知下降（52%比 18%；<0.01），尽管住院医师或研究员报告的患者错误没有显著变化。SBAR 保持了住院医师已经很高的咨询满意度（96%比 92%；=0.39），并提高了研究员的咨询满意度（51%比 91%；<0.001）。
实施标准化咨询沟通工具可增加 ECE 的纳入。该工具的使用提高了咨询问题的清晰度，降低了感知的沟通错误，并改善了整体咨询满意度。
