Dataset Information

Electronic checklists improve referral letters in gastroenterology: a randomized vignette survey.

ABSTRACT: Objective:Investigate whether gastroenterologists rate the quality of referral letters higher if electronic dynamic checklist items are added to a standard free-text referral letter. Assess how this affects the gastroenterologists' assessment of the patient's need for healthcare and the agreement between their assessments. Design:Randomized vignette study. Setting:Norwegian primary gastroenterology services. Participants:Thirty-two Norwegian gastroenterologists. Intervention:Between June 2015 and January 2016, participants were recruited through an open invitation to all members of the Norwegian Society of Gastroenterology. They were asked to rate 16 referral letters (vignettes) in a web interface: eight letters in free text following a general template and eight letters based on a general referral template combined with diagnosis-specific checklist items. The study was completed in two subsequent rounds ?3 months apart. Main Outcome Measures:Quality of referral letters assessed on a rating scale from 0 to 10. Agreement in the referral assessment and accuracy of the selection of correct preliminary diagnosis and appropriate work-up. Results:The mean quality assesses on the rating scale was 7.0 (95% confidence interval [CI] 6.8-7.2) for all letters combined (n = 511), 6.5(CI 6.2-6.8) for the free-text referrals (n = 256) and 7.5(CI 7.3-7.7) for the checklist referrals (n = 255) (P < 0.001, paired t-test). No difference was observed in the triage of the patients, but fewer gastroenterologists felt the need to collect additional information about the patients in the checklist group. Conclusion:Checklist items may ease the assessment of the referrals for gastroenterologists. We were not able to show that checklists significantly influence the management of patients.

SUBMITTER: Eskeland SL

PROVIDER: S-EPMC6047431 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Electronic checklists improve referral letters in gastroenterology: a randomized vignette survey.

Eskeland Sigrun Losada SL Rueegg Corina Silvia CS Brunborg Cathrine C Aabakken Lars L de Lange Thomas T

International journal for quality in health care : journal of the International Society for Quality in Health Care 20180701 6

<h4>Objective</h4>Investigate whether gastroenterologists rate the quality of referral letters higher if electronic dynamic checklist items are added to a standard free-text referral letter. Assess how this affects the gastroenterologists' assessment of the patient's need for healthcare and the agreement between their assessments.<h4>Design</h4>Randomized vignette study.<h4>Setting</h4>Norwegian primary gastroenterology services.<h4>Participants</h4>Thirty-two Norwegian gastroenterologists.<h4>I ...[more]

PMID: 29635304

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Project description:Extracorporeal membrane oxygenation-related complications are potentially catastrophic if not addressed quickly. Because complications are rare, high-fidelity simulation is recommended as part of the training regimen for extracorporeal membrane oxygenation specialists. We hypothesized that the use of standardized checklists would improve team performance during simulated extracorporeal membrane oxygenation emergencies.DesignRandomized simulation-based trial.SettingA quaternary-care academic hospital with a regional extracorporeal membrane oxygenation referral program.SubjectsExtracorporeal membrane oxygenation specialists and other healthcare providers.InterventionsWe designed six read-do checklists for use during extracorporeal membrane oxygenation emergencies using a modified Delphi process. Teams of two to three providers were randomized to receive the checklists or not. All teams then completed four simulated extracorporeal membrane oxygenation emergencies.Measurements and main resultsSimulation sessions were video-recorded, and the number of critical tasks performed and time-to-completion were compared between groups. A survey instrument was administered before and after simulations to assess participants' attitudes toward the simulations and checklists. We recruited 36 subjects from a single institution, randomly assigned to 15 groups. The groups with checklists completed more critical tasks than participants in the control groups (90% vs 75%; p < 0.001). The groups with checklists performed a higher proportion of both nontechnical tasks (71% vs 44%; p < 0.001) and extracorporeal membrane oxygenation-specific technical tasks (94% vs 86%; p < 0.001). Both groups reported an increase in reported self-efficacy after the simulations (p = 0.003). After adjusting for multiple comparisons, none of the time-to-completion measures achieved statistical significance.ConclusionsThe use of checklists resulted in better team performance during simulated extracorporeal membrane oxygenation emergencies. As extracorporeal membrane oxygenation use continues to expand, checklists may be an attractive low-cost intervention for centers looking to reduce errors and improve response to crisis situations.

Project description:BACKGROUND:We aimed to determine the best study designs for assessing interventions to improve the peer review process according to experts' opinions. Furthermore, for interventions previously evaluated, we determined whether the study designs actually used were rated as the best study designs. METHODS:Study design: A series of six vignette-based surveys exploring the best study designs for six different interventions (training peer reviewers, adding an expert to the peer review process, use of reporting guidelines checklists, blinding peer reviewers to the results (i.e., results-free peer review), giving incentives to peer reviewers, and post-publication peer review). Vignette construction: Vignettes were case scenarios of trials assessing interventions aimed at improving the quality of peer review. For each intervention, the vignette included the study type (e.g., randomized controlled trial [RCT]), setting (e.g., single biomedical journal), and type of manuscript assessed (e.g., actual manuscripts received by the journal); each of these three features varied between vignettes. PARTICIPANTS:Researchers with expertise in peer review or methodology of clinical trials. OUTCOME:Participants were proposed two vignettes describing two different study designs to assess the same intervention and had to indicate which study design they preferred on a scale, from -?5 (preference for study A) to 5 (preference for study B), 0 indicating no preference between the suggested designs (primary outcome). Secondary outcomes were trust in the results and feasibility of the designs. RESULTS:A total of 204 experts assessed 1044 paired comparisons. The preferred study type was RCTs with randomization of manuscripts for four interventions (adding an expert, use of reporting guidelines checklist, results-free peer review, post-publication peer review) and RCTs with randomization of peer reviewers for two interventions (training peer reviewers and using incentives). The preferred setting was mainly several biomedical journals from different publishers, and the preferred type of manuscript was actual manuscripts submitted to journals. However, the most feasible designs were often cluster RCTs and interrupted time series analysis set in a single biomedical journal, with the assessment of a fabricated manuscript. Three interventions were previously assessed: none used the design rated first in preference by experts. CONCLUSION:The vignette-based survey allowed us to identify the best study designs for assessing different interventions to improve peer review according to experts' opinion. There is gap between the preferred study designs and the designs actually used.

Project description:BackgroundGeneral practitioners (GPs) select few patients for specialist investigation. Having selected a patient, the GP writes a referral letter which serves primarily to convey concerns about the patient and offer background information. Referral letters to specialists sometimes provide an inadequate amount of information. The content of referral letters to colorectal surgeons can now be scored based on the views of GPs about the ideal content of referral letters.AimTo determine if written feedback about the contents of GP referral letters mediated by local peers was acceptable to GPs and how this feedback influenced the content and variety of their referrals.DesignA non-randomised control trial.SettingGPs in North Nottinghamshire.MethodIn a controlled trial, 26 GPs were offered written feedback about the documented contents of their colorectal referral letters over 1 year. The feedback was designed and mediated by two nominated local GPs. The contents of referral letters were measured in the year before and 6 months after feedback. GPs were asked about the style of the feedback. The contents of referral letters and the proportion of patients with organic pathology were compared for the feedback GPs and other local GPs who could be identified as having used the same hospital for their referrals in the period before and after feedback.ResultsAll GPs declared the method of feedback to be acceptable but raised concerns about their own performance, and some were upset by the experience. None withdrew from the project. There was a difference of 7.1 points (95% confidence interval = 1.9 to 12.2) in the content scores between the feedback group and the controls after adjusting for baseline differences between the groups. Of the GPs who referred to the same hospital before and after feedback, the feedback GPs referred more patients with organic pathology than other local colleagues.ConclusionsGPs welcome feedback about the details appearing on their referral letters, although peer comparisons may not always lead to changes in practice. However, in some cases feedback improves the content of GP referral letters and may also impact on the type of patients referred for investigation by specialists.

Project description:BACKGROUND:Improving response rates in epidemiologic studies is important for the generalizability of the outcome. The aim of this study was to examine whether it can be advantageous for participation to target different versions of the cover letters to different sample subgroups. METHODS:A randomized trial was incorporated in a cross-sectional health survey in Denmark (n =?25,000) where a motivational sentence in the cover letter intended to heighten perceptions of relevance of the survey was varied among 11 sample subgroups (treatment groups). Ten different versions of a sentence outlining questionnaire themes were tested: each mentioned three out of five themes: stress, alcohol, sex, sleep problems, and contact with family and friends. An eleventh group, the control group, omitted this sentence. RESULTS:On average, the additional motivational sentence resulted in a significantly lower response rate overall compared to the control group. However, the additional motivational sentence was found to have heterogeneous effects on survey response. Furthermore, the nature of the heterogeneity differed between the versions of the sentence. Specifically, the additional sentence tended to produce a higher response rate among the youngest age group and a lower response rate in the oldest age group compared to the generic letter. The use of alcohol in the motivational sentence tended to have a positive effect on response in the age group 16-24?years, and stress tended to have a positive effect in the age group ?65?years. On the contrary, sex tended to have a negative effect in the age groups 45-64?years and???65?years. However, a significant interaction was only found between the use of stress and age group (p?=?<?0.0001). CONCLUSION:The findings of significant and heterogeneous effects suggest that there is potential for a targeted approach to improve both response rates and sample composition. The uneven effect of the separate themes across age groups suggests that the selection of themes to be included in the motivational sentence is important for the use of targeted appeals to be successful and warrants further research to better identify which themes works in which contexts, in which subgroups and under which circumstances. TRIAL REGISTRATION:ClinicalTrials.gov ID: NCT03046368 , retrospectively registered February 8th, 2017.

Dataset Information

Electronic checklists improve referral letters in gastroenterology: a randomized vignette survey.

Publications

Electronic checklists improve referral letters in gastroenterology: a randomized vignette survey.

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