Optimizing Hospitalist-Patient Communication: An Observation Study of Medical Encounter Quality

Perceptions of Health Professionals about the Quality of Communication and Deliberation with the Patient and its Impact on the Health Decision Making Process

“…Nursing studies focus on the effectiveness of nurses’ communication with patients 19-21 and the nurses’ attitudes towards communication with patients. 12-24 Giménez-Esperta and Prado Gascó 24 explored the association and predictive value of attitude components (behavioural, cognitive and affective) with communication behaviour and found the highest scores in cognitive and behavioural dimensions, while the scores were worse in the affective component. Also, most of the professionals in our study (93.8%) answered that they adapt the communicative process to the age and educational level of the patient.…”

Habilidades comunicacionales del médico. Experiencia en el Departamento de Medicina de un hospital pediátrico.

“…Hallazgos similares fueron también observados por Salazar Blanco y col. en su trabajo realizado en la Universidad de Antioquia, quienes observaron que en las entrevistas predominaban los aspectos biológicos de la enfermedad por sobre la comprensión del sujeto y la relación emocional que promueve el modelo biopsicosocial (16) . Apker y col (17) , luego de realizar 206 observaciones de entrevistas médico/paciente en el contexto de internación, también describen este elemento de la comunicación como el peor puntuado. En su trabajo, observaron a cada médico en varias oportunidades con pacientes distintos, no pudiendo determinar un patrón de comportamiento del médico, sino que observaron que dependía del paciente y su entorno.…”

“…Encontraron como posible barrera a la hora de comprender la perspectiva del paciente las distracciones en el ambiente (por ejemplo: un ruido molesto, la televisión de la habitación prendida, el uso de pantallas por parte del paciente, etc.). Otro elemento en el que los profesionales obtuvieron menor puntaje fue "alcanzar un acuerdo", observación también coincidente con Apker y col (17) . Alcanzar acuerdos es un proceso complejo que exige la recopilación y el intercambio de información sobre el conocimiento que el paciente tiene de los aspectos biomédicos, así como de sus sentimientos, preocupaciones y preferencias.…”

A STEEEP Hill to Climb: A Scoping Review of Assessments of Individual Hospitalist Performance

“…Studies coded to the Patient Centered domain assessed hospitalist performance through ratings of patient satisfaction, 8,9,[41][42][43][44] rating of communication between hospitalists and patients, [19][20][21]29,[45][46][47][48][49][50][51] identification of patient preferences, 38,52 outcomes of patient-centered care activities, 27,28 and peer ratings. 53,54 Authors applied several theoretical constructs to these assessments including shared decision-making, 50 etiquette-based medicine, 47,48 empathetic responsiveness, 45 agreement about the goals of care between the patient and healthcare team members, 52 and lapses in professionalism.…”

“…Applying the six domains of the STEEEP framework revealed the multidimensional outcomes of hospitalist work and could guide more meaningful quality assessments of individual hospitalist performance. For example, assessing adherence to evidence-based guidelines, as well as consideration of the Core Competencies of Hospital Medicine and recommendations of the Choosing Wisely® campaign, are Evidence/guideline application Evaluation of performance in simulated cases: COPD and sepsis 32 Assessment of frequency of guideline-concordant treatment for target pediatric conditions 34 Appraisal of frequency of repeat common lab studies done within 24 hours of normal values 37 Sign-out for cross-covering providers Survey of cross-covering provider on sign-out adequacy for patient inquiries 15 Iterative scoring of sign-outs on 13 desired elements 16 Handoffs to new primary provider 18-item survey of new primary provider within 48 hours of assuming care 17 Time spent on various activities Observation of work process by trained observers 30,31 Cost Patient scores on a fifteen 5-point items 42,43 Recurring daily patient scores on three 4-point items 44 Collated system metrics including patient satisfaction scores 8,9 Communication between hospitalist and patients Coded admission encounters for end-of-life goals in seriously ill patients 29 Coding of patient conversations for empathic utterances by the hospitalist 45 Scoring by a trained observer via a 26-item, 5-point tool 46 ; a 23-item, dichotomous checklist of behaviors 47 ; or a six-item, dichotomous checklist for etiquette behaviors 48 Scoring by patients via a fourteen-item, 5-point tool 49 Scoring by observers and patients via a nine-item tool for shared decision-making 50 Evaluation of performance in simulated cases: rounding, discharge, and conflict 51 Review of discharge summaries for required and recommended elements, as well as readability [19][20][21] Patient preferences for care Chart review for documented patient preferences within first day of admission 38 Concordance among patient, provider, and nurse for one of seven primary recovery goals 52 Resolution of discharge barriers 12-item checklist of barriers completed daily by patients ...…”