Shared Decision‐Making During Inpatient Rounds: Opportunities for Improvement in Patient Engagement and Communication

Abstract

Important opportunities exist to improve inpatient SDM. Team size, number of learners, patient census, and type of decision being made did not affect SDM, suggesting that even large, busy services can perform SDM if properly trained.

Sex and gender considerations in implementation interventions to promote shared decision making: A secondary analysis of a Cochrane systematic review

“…There is an ethical imperative to involve patients in making important health decisions [5] and SDM is appearing in legislation governing healthcare in numerous countries [6,7]. SDM can improve patient engagement [8][9][10][11], satisfaction and adherence to drug therapy [12], and contributes to the optimization of health service utilization and health costs [13]. SDM improves patient experiences and the quality of care provided by health professionals [14].…”

Predicting in-hospital mortality for patients admitted from the emergency department: An initial alarm score for inpatient care

“…However, whether patients have cancer with or without metastasis may provide little insight on the poor prognosis, and as high as 25% of terminal cancer patients receive vasopressors in the dying process [17]. Therefore, hospitalists need to hold family meetings to explain and discuss treatment plans for shared decision making on cancer patients with high prediction scores [18].…”

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. 53 Studies often crossed STEEEP domains, such as those assessing quality of discharge information provided to patients, which were coded as both Safe and Patient Centered.…”

“…[19][20][21] In addition to coded or observed performance in the clinical setting, studies in this domain also used patient ratings as a method of assessment. 8,9,28,[41][42][43][44]49,50 Only a few of these approaches aligned with existing performance measures of health systems and were more automated.…”

“…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 ...…”