Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Med Educ Online. 2022 Dec;27(1):2024115. doi: 10.1080/10872981.2021.2024115.
As part of a quality improvement project, we developed and employed an observation checklist to measure patient-centered behaviors during daily rounds to assess the frequency of patient-centered behaviors among a patient-centered care (PCC) team and standard team (ST) rounds.
On four general medicine service (GMS) teaching teams at an urban academic medical center in which housestaff rotate, we utilized an observation checklist to assess the occurrence of eight behaviors on inpatient daily rounds. The checklist covered domains of patient-centered communication, etiquette-based behaviors, and shared decision-making. One GMS team is guided by a PCC curriculum that emphasizes patient-centered communication strategies, but not specifically behaviors during bedside rounds.
Between August 2018 and May 2019 a trained observer completed 448 observations of patient rounding encounters using the checklist. Across all teams, 46.0% of the 8 behaviors were performed when possible, with more done on the PCC team (58.0%) than ST (42.0%), p < 0.01.
Performance of patient-centered behaviors during daily rounds was low overall. Despite having no specific instruction on daily rounds, patient-centered behaviors were more frequent among the teams which were part of a PCC curriculum. However, the frequency of observed behaviors was modest, suggesting that more explicit efforts to change rounding behaviors are needed. Our observational checklist may be a tool to assist in future interventions to improve patient-centered behaviors on daily rounds.
作为一项质量改进项目的一部分，我们开发并使用了观察检查表来衡量日常查房中的以患者为中心的行为，以评估以患者为中心的护理 (PCC) 团队和标准团队 (ST) 查房中以患者为中心的行为的频率。
在城市学术医疗中心的四个普通内科服务 (GMS) 教学团队中，我们利用观察检查表评估住院患者日常查房中的八项行为发生情况。检查表涵盖以患者为中心的沟通、基于礼仪的行为和共同决策领域。一个 GMS 团队遵循 PCC 课程，该课程强调以患者为中心的沟通策略，但不特别强调床边查房时的行为。
在 2018 年 8 月至 2019 年 5 月期间，一名经过培训的观察员使用检查表完成了 448 次患者查房观察。在所有团队中，有 46.0%的 8 种行为是在可能的情况下完成的，PCC 团队（58.0%）比 ST 团队（42.0%）更多，p < 0.01。
总体而言，日常查房中以患者为中心的行为表现较低。尽管没有关于日常查房的具体指导，但作为 PCC 课程一部分的团队中，以患者为中心的行为更为频繁。然而，观察到的行为频率适中，这表明需要更明确地努力改变查房行为。我们的观察检查表可能是一种辅助未来干预措施的工具，以改善日常查房中的以患者为中心的行为。
