Development of validation of a tool to assess the Quality of Information (QUIT)
Y Reissis, M Johnston, S Arora, P Pucher, D King, A Darzi
Introduction
Failures in communication and information transfer when escalating care for
deteriorating patients are the root cause for many adverse events
1, 2, 3.
.
Successful escalation of care relies on the effective communication of patient
deterioration to a senior colleague who can implement definitive
management. However, the lack of an assessment system for doctors’ skills
in this area places patient safety at risk.
Aims
Our study aimed to develop and validate a psychometric tool to assess junior
doctors’ skills in information transfer when escalating patient car
Methods
The tool was developed using a literature review and stakeholder interviews,
and compiled by an expert panel. Psychometric testing of the tool assessed:
1) face and content validity using stakeholders surveys; and 2) construct
validity by investigating whether the tool could differentiate between the
quality of information transfer of novices (n=15) and experts (n=15) in a
simulated scenario that involved assessing a deteriorating post-operative
patient (Fig.1).
Fig.1.
Key actions and findings as they occurred chronologically during the simulated
scenario. The roles of the patient and nurse were played by members of the research
team (YR and MJ respectively). The phone calls were analysed using the QUIT tool.
RESULTS
The QUality of Information Transfer (QUIT) tool consisted of 7 categories
and 24 items rated using a 5-point Likert scale (Fig.2). The tool had good
face validity and 21/24 items had excellent content validity (CVI>0.82) (Fig.
3). All 7 categories and 18/24 items were construct valid (p<0.05) as shown
in Fig.4. Experts scored significantly higher than novices in communicating
the patient’s location (median score 5.0 vs. 1.0) and in presenting the
information in a structured and logical order (median score 4.0 vs. 2.0).
Inter-rater reliability was high for all 7 categories (ICC>0.7) with a
Cronbach’s alpha value of >0.8.
CONCLUSIONS
The QUIT tool is the first validated tool to accurately assess the quality of information transfer when escalating care for deteriorating patients. This tool can act as a standard to guide the evidence-based
assessment and training of junior doctors’ skills in this area, which can enhance communication between healthcare teams and ultimately improve patient safety. Future work will look to prove the
feasibility of the QUIT tool for use in the real hospital setting, with the
aim of implementing the tool in a checklist form on the wards.
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