Soto Jacome Cristian, Espinoza Suarez Nataly R, Golembiewski Elizabeth H, Gravholt Derek, Crowley Aidan, Urtecho Meritxell, Garcia Leon Montserrat, Mandhana Dron, Ballard Dawna, Kunneman Marleen, Prokop Larry, Montori Victor M
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Department of Internal Medicine, Norwalk Hospital, Nuvance Health, CT, USA.
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada; Faculty of Nursing, Université Laval, Quebec City, Quebec, Canada.
Patient Educ Couns. 2025 Feb;131:108591. doi: 10.1016/j.pec.2024.108591. Epub 2024 Nov 30.
Hurried encounters in clinical settings contribute to dissatisfaction among both patients and clinicians and may indicate and contribute to low-quality care. We sought to identify patient- or clinician-reported instruments concerning this experience of time in clinical encounters.
We searched multiple databases from inception through July 2023. Working in duplicate without restrictions by language or clinical context, we identified published instruments or single items measuring perceptions of time adequacy in clinical encounters. We characterized these by time domain (perceived duration or pace of the encounter), responder (patient or clinician), and reference (experience of care in general or of a particular encounter).
Of the 96 instruments found, none focused exclusively on perception of time adequacy in clinical encounters. Nonetheless, these instruments contained 107 time-related items. Of these, 81 items (77 %) measured the perception of the encounter duration, assessing whether there was adequate consultation time overall or for specific tasks (e.g., listening to the patient, exploring psychosocial issues, formulating the care plan). Another 19 (18 %) assessed encounter pace, and 7 (7 %) assessed both duration and pace. Pace items captured actions perceived as rushed or hurried or the perception that patients and clinicians felt pressed for time or rushed. Patients were the respondents for 76 (71 %) and clinicians for 24 (22 %) items. Most patient-reported items (48 of 76) referred to the patient's general care experience.
There are existing items to capture patient and clinician perceptions of the duration and/or pace of clinical encounters. Further work should ascertain their ability to identify hurried consultations and to detect the effect of interventions to foster unhurried encounters.
The available items assessing patient and clinician perceptions of duration and pace can illuminate the experience of time adequacy in clinical encounters as a target for quality improvement interventions. These items may capture unintended consequences on perceived time for care of interventions to improve healthcare access and efficiency.
临床环境中的仓促问诊会导致患者和临床医生双方都不满意，并且可能预示着低质量护理并促成这种情况。我们试图确定患者或临床医生报告的与临床问诊中这种时间体验相关的工具。
我们检索了多个数据库，时间范围从数据库创建至2023年7月。我们两人独立工作，不受语言或临床背景限制，识别已发表的用于测量临床问诊中时间充足感认知的工具或单个项目。我们根据时域（感知到的问诊持续时间或节奏）、应答者（患者或临床医生）和参考内容（一般护理体验或特定问诊体验）对这些工具进行了特征描述。
在找到的96种工具中，没有一种专门关注临床问诊中时间充足感的认知。尽管如此，这些工具包含107个与时间相关的项目。其中，81个项目（77%）测量了对问诊持续时间的认知，评估总体或特定任务（如倾听患者、探讨心理社会问题、制定护理计划）是否有足够的咨询时间。另外19个项目（18%）评估了问诊节奏，7个项目（7%）同时评估了持续时间和节奏。节奏项目涵盖了被视为仓促或匆忙的行为，或者患者和临床医生感到时间紧迫或匆忙的认知。76个项目（71%）的应答者为患者，24个项目（22%）的应答者为临床医生。大多数患者报告的项目（76个中的48个）涉及患者的总体护理体验。
现有项目可用于捕捉患者和临床医生对临床问诊持续时间和/或节奏的认知。进一步的工作应确定它们识别仓促问诊以及检测促进从容问诊干预措施效果的能力。
现有的评估患者和临床医生对持续时间和节奏认知的项目，可以阐明临床问诊中时间充足感的体验，作为质量改进干预措施的目标。这些项目可能捕捉到改善医疗服务可及性和效率的干预措施对感知护理时间产生的意外后果。
