Improving Escalation of Care Development and Validation of the Quality of Information Transfer Tool

Title: Improving Escalation of Care Development and Validation of the Quality of Information Transfer Tool
Authors: Johnston, MJ
Arora, S
Pucher, PH
Reissis, Y
Hull, L
Huddy, JR
King, D
Darzi, A
Item Type: Journal Article
Abstract: Objective: To develop and provide validity and feasibility evidence for the QUality of Information Transfer (QUIT) tool. Background: Prompt escalation of care in the setting of patient deterioration can prevent further harm. Escalation and information transfer skills are not currently measured in surgery. Methods: This study comprised 3 phases: the development (phase 1), validation (phase 2), and feasibility analysis (phase 3) of the QUIT tool. Phase 1 involved identification of core skills needed for successful escalation of care through literature review and 33 semistructured interviews with stakeholders. Phase 2 involved the generation of validity evidence for the tool using a simulated setting. Thirty surgeons assessed a deteriorating postoperative patient in a simulated ward and escalated their care to a senior colleague. The face and content validity were assessed using a survey. Construct and concurrent validity of the tool were determined by comparing performance scores using the QUIT tool with those measured using the Situation-Background-Assessment-Recommendation (SBAR) tool. Phase 3 was conducted using direct observation of escalation scenarios on surgical wards in 2 hospitals. Results: A 7-category assessment tool was developed from phase 1 consisting of 24 items. Twenty-one of 24 items had excellent content validity (content validity index >0.8). All 7 categories and 18 of 24 (P < 0.05) items demonstrated construct validity. The correlation between the QUIT and SBAR tools used was strong indicating concurrent validity (r = 0.694, P < 0.001). Real-time scoring of escalation referrals was feasible and indicated that doctors currently have better information transfer skills than nurses when faced with a deteriorating patient. Conclusions: A validated tool to assess information transfer for deteriorating surgical patients was developed and tested using simulation and real-time clinical scenarios. It may improve the quality and safety of patient care on the surgical ward.
Issue Date: 1-Mar-2016
Date of Acceptance: 1-Mar-2016
ISSN: 0003-4932
Publisher: Wolters Kluwer Health, Inc.
Start Page: 477
End Page: 486
Journal / Book Title: ANNALS OF SURGERY
Volume: 263
Issue: 3
Copyright Statement: © 2016 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form in Annals of Surgery 263(3), March 2016, p 477–486,
Sponsor/Funder: National Institute for Health Research
Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
Funder's Grant Number: NF-SI-0510-10186
RDPSC 79560
RDPSC 79560
Keywords: Science & Technology
Life Sciences & Biomedicine
escalation of care
information transfer
patient safety
Clinical Competence
Education, Medical, Graduate
Feasibility Studies
General Surgery
Interdisciplinary Communication
Internship and Residency
Interviews as Topic
Patient Handoff
Postoperative Complications
Quality of Health Care
Referral and Consultation
11 Medical And Health Sciences
Publication Status: Published
Online Publication Date: 2016-03-01
Appears in Collections:Division of Surgery
Faculty of Medicine

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