Cecilia Makiwane Hospital, East London, South Africa.
Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University and Head of Department, Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, South Africa.
BMC Med Educ. 2022 Jul 13;22(1):538. doi: 10.1186/s12909-022-03602-5.
Well performed clinical communication is a cornerstone of collaborative care in medicine but may be confounded by inconsistent intentions of the messenger and biased interpretation by the recipient. A comparison of the findings of electronic echocardiography reports with clinician-completed standardised request forms provided an opportunity to assess communication quality.
The study aimed to determine clinician aptitude to complete written echocardiography referral forms by assessing the completeness, appropriateness, accuracy, and coherency of the reported clinical findings, conclusions and requests made on the referral forms. The study explored factors that may influence the quality of communication through this referral medium.
A retrospective cohort study was conducted on patients who underwent trans-thoracic echocardiography imaging at Cecilia Makiwane Hospital in East London over 26 months. Paper echocardiography request forms that recorded the requesting clinician's findings on examination, the provisional clinical diagnosis, and the specific echocardiographic information sought, were compared with the actual findings on echocardiography.
Of 613 request forms reviewed, 97 cases were excluded due to illegibility or because they lacked analysable information or requester details, leaving 516 forms suitable for study. No pathology was found on echocardiography in 31%. Of the murmurs expected from the echocardiography findings, only half were recorded on the request form (sensitivity and positive predictive value both 52%.). Only 35% of request forms that mentioned a mitral systolic murmur gave a working diagnosis of mitral regurgitation and only 38% of request forms that mentioned an aortic systolic murmur considered aortic stenosis. Clinically suspected cardiomyopathy (CMO) had a PPV of 43% and echocardiographic CMO was missed clinically in 41%. Apex beat displacement reported clinically was not associated with echocardiographic LV dilatation in 65% of cases. One-third (34%) of forms reporting murmurs did not request valve function assessment and 17% considering cardiomyopathy did not request left ventricular function assessment.
Echocardiography request forms highlight vulnerabilities in clinical communication. Specifically, important clinical features were missing and more concerningly, included when unlikely to be present. There was a lack of concordance between recorded clinical findings and postulated diagnoses. Clinicians sometimes appeared unclear about the value or appropriateness of the requested assistance. Greater emphasis on teaching examination and communication skills may foster safer and more efficient use of scarce resources.
良好的临床沟通是医学协作护理的基石，但发讯者的意图不一致和收讯者的有偏差解读可能会使沟通变得复杂。电子超声心动图报告的结果与临床医生完成的标准化请求表进行比较，为评估沟通质量提供了机会。
本研究旨在通过评估报告的临床发现、结论和请求在转诊表上的完整性、适当性、准确性和连贯性，来确定临床医生完成书面超声心动图转诊表的能力。该研究探讨了通过这种转诊方式影响沟通质量的因素。
对在东伦敦塞西莉亚·马基瓦内医院接受经胸超声心动图成像的患者进行了回顾性队列研究。在 26 个月的时间里，对记录了检查时请求医生发现、临时临床诊断以及具体超声心动图信息的纸质超声心动图请求表与超声心动图的实际发现进行了比较。
在审查的 613 份请求表中，有 97 份因字迹不清或缺乏可分析信息或请求者详细信息而被排除在外，剩下 516 份适合研究。31%的患者在超声心动图上未发现任何病变。在可从超声心动图发现的杂音中，只有一半记录在请求表上（敏感性和阳性预测值均为 52%）。只有 35%提到二尖瓣收缩期杂音的请求表给出了二尖瓣反流的工作诊断，只有 38%提到主动脉瓣收缩期杂音的请求表考虑了主动脉瓣狭窄。临床上疑似扩张型心肌病（CMO）的阳性预测值为 43%，临床上漏诊了 41%的超声心动图 CMO。临床上报告的心尖搏动移位与 65%的病例中左心室扩张的超声心动图结果无关。三分之一（34%）的报告杂音的表格没有要求评估瓣膜功能，而 17%考虑心肌病的表格没有要求评估左心室功能。
超声心动图请求表突出了临床沟通中的脆弱性。具体来说，重要的临床特征缺失，更令人担忧的是，包括不太可能存在的特征。记录的临床发现与假设诊断之间缺乏一致性。临床医生有时似乎不清楚所请求协助的价值或适当性。更加强调检查和沟通技巧的教学可能会促进更安全、更有效地利用稀缺资源。
