Listening and question-asking behaviors in resident and nurse handoff conversations: a prospective observational study

Improving handover competency in preclinical medical and health professions students: establishing the reliability and construct validity of an assessment instrument

BACKGROUND

As part of the worldwide call to enhance the safety of patient handovers of care, the Association of American Medical Colleges (AAMC) requires that all graduating students "give or receive a patient handover to transition care responsibly" as one of its Core Entrustable Professional Activities (EPAs) for Entering Residency. Students therefore require educational activities that build the necessary teamwork skills to perform structured handovers. To date, a reliable instrument designed to assess teamwork competencies, like structured communication, throughout their preclinical and clinical years does not exist.

METHOD

Our team developed an assessment instrument that evaluates both the use of structured communication and two additional teamwork competencies necessary to perform safe patient handovers. This instrument was utilized to assess 192 handovers that were recorded from a sample of 229 preclinical medical students and 25 health professions students who participated in a virtual course on safe patient handovers. Five raters were trained on utilization of the assessment instrument, and consensus was established. Each handover was reviewed independently by two separate raters.

RESULTS

The raters achieved 72.22 % agreement across items in the reviewed handovers. Krippendorff's alpha coefficient to assess inter-rater reliability was 0.6245, indicating substantial agreement among the raters. A confirmatory factor analysis (CFA) demonstrated the orthogonal characteristics of items in this instrument with rotated item loadings onto three distinct factors providing preliminary evidence of construct validity.

CONCLUSIONS

We present an assessment instrument with substantial reliability and preliminary evidence of construct validity designed to evaluate both use of structured handover format as well as two team competencies necessary for safe patient handovers. Our assessment instrument can be used by educators to evaluate learners' handoff performance as early as their preclinical years and is broadly applicable in the clinical context in which it is utilized. In the journey to optimize safe patient care through improved teamwork during handovers, our instrument achieves a critical step in the process of developing a validated assessment instrument to evaluate learners as they seek to accomplish this goal.

Human Factors and Organizational Issues in Health Informatics: Innovations and Opportunities

OBJECTIVE

Human factors and ergonomics (HF/E) frameworks and methods are becoming embedded in the health informatics community. There is now broad recognition that health informatics tools must account for the diverse needs, characteristics, and abilities of end users, as well as their context of use. The objective of this review is to synthesize the current nature and scope of HF/E integration into the health informatics community.

METHODS

Because the focus of this synthesis is on understanding the current integration of the HF/E and health informatics research communities, we manually reviewed all manuscripts published in primary HF/E and health informatics journals during 2020.

RESULTS

HF/E-focused health informatics studies included in this synthesis focused heavily on EHR customizations, specifically clinical decision support customizations and customized data displays, and on mobile health innovations. While HF/E methods aimed to jointly improve end user safety, performance, and satisfaction, most HF/E-focused health informatics studies measured only end user satisfaction.

CONCLUSION

HF/E-focused health informatics researchers need to identify and communicate methodological standards specific to health informatics, to better synthesize findings across resource intensive HF/E-focused health informatics studies. Important gaps in the HF/E design and evaluation process should be addressed in future work, including support for technology development platforms and training programs so that health informatics designers are as diverse as end users.

Measuring the quality of patient-physician communication

Patient-physician communication is an often overlooked yet a very important aspect of providing medical care. Positive patient-physician quality of communication within discourse has an influence on various aspects of a consultation such as a patient's treatment adherence to prescribed medical regimen and their medical care outcome. As few reference standards exist for exploring semantics within the patient-physician setting and its effects on personalized healthcare, this paper presents a study exploring three methods to capture, model and evaluate patient-physician communication among three distinct data-sources. We introduce, compare and contrast these methods for capturing and modeling patient-physician communication quality using relatedness between discourse content within a given consultation. Results are shown for all three data-sources and communication quality scores among physicians recorded. We found our models demonstrate the ability to capture positive communication quality between both participants within a consultation. We also evaluate these findings against self-reported questionnaires highlighting various aspects of the consultation and rank communication quality among seventeen physicians who consulted amid one-hundred and thirty-two patients.