A Prospective, Randomized, Controlled Study Demonstrating a Novel, Effective Model of Transfer of Care between Physicians: The 5 Cs of Consultation

Academic Emergency Medicine - Tập 19 Số 8 - Trang 968-974 - 2012
Chad Kessler1,2,3,4, Yalda Afshar1,2,3,4, Gurkiran Sardar1,2,3,4, Rachel Yudkowsky1,2,3,4, Felix Ankel1,2,3,4, Alan Schwartz1,2,3,4
1From the Departments of Emergency Medicine, Jesse Brown VA Hospital, and University of Illinois-Chicago (CSK), Chicago, IL
2the College of Medicine (YA, GS), University of Illinois-Chicago, Chicago, IL
3the Department of Emergency Medicine, University of Minnesota Medical School (FA), Minneapolis, MN. Dr. Afshar is currently with the Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA.
4the Department of Medical Education (RY, AS), College of Medicine, University of Illinois-Chicago, Chicago, IL

Tóm tắt

ACADEMIC EMERGENCY MEDICINE 2012; 19:968–974 © 2012 by the Society for Academic Emergency MedicineAbstractObjectives:  The objective was to evaluate whether a standardized consultation model in the emergency department (ED), the 5 Cs of Consultation (Contact, Communicate, Core Question, Collaboration, and Closing the Loop), would improve physicians’ ability to relay appropriate information and communicate successfully during a consultation.Methods:  This was a prospective, randomized study at a large, academic, urban, tertiary care medical center in Chicago. Forty‐three emergency medicine (EM) and EM/internal medicine (EM/IM) residents were randomized into two groups, an intervention group and an unstructured group, stratified by postgraduate year (PGY). Intervention group participants received an interactive educational session on the 5 Cs of Consultation, a standardized consultation model. Intervention and unstructured groups placed two simulated consultation phone calls, based on pretested simulated patient cases, to a standardized consultant. Three raters, naive to the consultation model and blinded to group assignments, individually assessed recordings of each call using a seven‐item, five‐point global rating scale (GRS). Finally, an attending surgeon and an attending psychiatrist each rated respective cases using a single global rating to provide validity evidence for the scale.Results:  Residents trained with the 5 Cs model communicated significantly better, regardless of PGY and clinical case. The intervention group had significantly higher mean GRS scores than the unstructured group (4.1 vs. 3.5, F(1,39) = 33.5, p < 0.0001). Secondary analysis of the recordings suggested that encounters with more 5 Cs behaviors tended to receive higher GRS scores.Conclusions:  A standardized educational model increased the effectiveness of consultation communication from the ED. Residents trained with the 5 Cs of Consultation scored better on consultation assessments compared with untrained residents. Training programs should consider adopting standardized consultation models.

Từ khóa


Tài liệu tham khảo

Joint Commission.Sentinel Event Statistics: As of March 31 2008. Updated file available at:http://www.jointcommission.org/sentinel_event.aspx. Accessed May 28 2012.

10.1016/j.annemergmed.2009.07.016

10.1136/emj.2003.008409

10.1136/emj.2007.051631

Joint Commission, Sentinel Event Alert: Delays in Treatment

MatthewsA HarveyCM SchusterRJ et al.Emergency physician to admitting physician handovers: an exploratory study. Proc Human Factors Ergonomics Soc. 46th Annual Meeting. Baltimore MD September 30–October 4 2002.

10.1111/j.1742-6723.2007.00984.x

Institute of Medicine, 1999, To Err Is Human: Building a Better Health Care System

10.1016/0959-8049(96)00151-7

10.1111/j.1553-2712.2003.tb01350.x

10.1080/03637750500322602

Guertler AT, 1994, Referral and consultation in emergency medicine practice, Acad Emerg Med., 11, 565, 10.1111/j.1553-2712.1994.tb02557.x

ACGME.Outcome Project. General Competencies. Available at:http://www.acgme.org/acWebsite/irc/irc_competencies.asp. Accessed May 28 2012.

10.1016/j.jemermed.2011.01.025

Cope M, 2003, The Seven Cs of Consulting: The Definitive Guide to the Consulting Process

Lyn Paul C, 2008, A modified Delphi approach to a new card sorting methodology, J Usability Stud., 4, 7

Custer RL, 1999, The modified Delphi technique‐‐a rotational modification, J Vocat Tech Educ., 15, 50

10.1111/j.1365-2929.2006.02544.x

10.1080/01421590903002821

10.1080/03610929408831436

Nunnally JC, 1978, Psychometric Theory

Landsberger HA, 1958, Hawthorne Revisited: Management and the Worker, Its Critics, and Developments in Human Relations in Industry

10.1002/job.4030060203

Thông tin
Thông tin xuất bản

Academic Emergency Medicine

Tập 19 Số 8

968-974

Thông tin tác giả