Improving Escalation of Care: Development and Validation of the Quality of Information Transfer Tool. Issue 3 (March 2016)

• Record Type: Journal Article
• Authors: Johnston, Maximilian J.; Arora, Sonal; Pucher, Philip H.; Reissis, Yannis; Hull, Louise; Huddy, Jeremy R.; King, Dominic; Darzi, Ara
• Is Part Of: Annals of surgery. Volume 263:Issue 3(2016:Mar.)
• Publication Date: 2016-03
• Subjects: communication -- escalation of care -- information transfer -- patient safety -- simulation -- validation; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001164
• Languages: English
• ISSNs: 0003-4932

Abstract

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.