I don't know about you, but sometimes I long for days to bypass "process." Then, I go through the steps and realize that process flushes out those hidden elements, getting me to visualize the research from start to finish.
http://issuu.com/ddbwaco/docs/burleson_research_proposal
Friday, February 20, 2009
Sunday, February 15, 2009
The Journey to Familiarity
Last week’s MOO session provided me with lots of fodder (thank you, Becky, for introducing me to a new use of this word). One of the discussions we had centered on recruiting. We were discussing this in the context of the usability study, but I also am filtering much of our discussion through my study lens. Just as a refresher, two statements lead into my discussion: Rob "right people = available people" Becky says, "so how can we make sure we're not recruiting "to suit our needs"?"
My study this semester focuses on interviewing hospitalists with what I’ll call a traditional pattern of questions and then moving to a “think out loud” protocol. From one perspective, I’m asking these physicians because they do suit my needs. A few I have interviewed before, I know some of the key hospital staff and so the trust is there, and the hospital is located in my city. However, I think the bigger picture is do the people that we recruit (and I know this was in a slightly different context than mine) meet the standards of our study: age group, socioeconomic group, etc.
One other point that I’ve realized after my first study is one of familiarity when conducting research. While simultaneously improving familiarity, two other areas are needed. I hope to conduct research in hospitalist communication practices but on a much broader scale with my dissertation. My mission along the way is twofold: practice and grant money. I have consulted with numerous professors who have told me that it is helpful to present a local study and show results when applying for grant dollars. I’ve also realized that interviewing is very difficult. In listening to some of my first audiotapes, I talked and talked… Some of you might listen to the tapes and not have the same reaction, but I did.
Geertz, in his essay “The Interpretation of Cultures,” notes that what prevents us from understanding is not our ignorance or lack of cognition but a lack of familiarity. He also uses the expression, “finding our feet.” (13) Last semester, I was accepted in the doctoral program and knew many more studies were down the road for me. I have long recognized that I needed to know more about the hospitalist profession before I totally embarrassed myself in an interview. So, while this is longer than I meant it to be, I wanted to share a story about my journey toward familiarity:
In searching for more articles/information about the profession, I found an article by a physician. While reading the article, I was also spending time searching for hospitalist internships, which are just beginning to be introduced in medical schools. Since the profession began in 1996, there has been no formal training within the internist’s educational process. In searching, I also found that this physician is the Director of Education for a hospitalist intern program at John’s Hopkins Hospital (Baltimore). I sent him an email last November with all the necessary information and asking if he could send me information about the program and wanting to discuss the program with him. Two weeks ago, I received an email from him apologizing for the delay and asking if I still wanted to visit with him. It took us about a week to connect, and we had a 30 minute visit. From the visit I realized that some fundamental “familiar” areas I had presumed to be correct were slightly skewed. Close but not really. From the visit, he has faxed me a brochure, sent an email to a graduate of the program asking if she would contact me, given me suggestions as to funding sources, and opened the door to research at his hospital.
In my journey, familiarity has had a ripple effect, and I realize that this visit is just the beginning. Maybe later I'll share about being prepared. In the first few phone calls, his assistant had led me to understand that he might meet with me at a conference, etc. (in other words, possibly never) and his scheduled was packed. So, when I called and she said, "please hold, he can talk with you NOW" I had a minimal amount of paper - what a hoot in trying to read my notes left to right, up one side and down the other, etc.
Thanks for reading,
Debra
My study this semester focuses on interviewing hospitalists with what I’ll call a traditional pattern of questions and then moving to a “think out loud” protocol. From one perspective, I’m asking these physicians because they do suit my needs. A few I have interviewed before, I know some of the key hospital staff and so the trust is there, and the hospital is located in my city. However, I think the bigger picture is do the people that we recruit (and I know this was in a slightly different context than mine) meet the standards of our study: age group, socioeconomic group, etc.
One other point that I’ve realized after my first study is one of familiarity when conducting research. While simultaneously improving familiarity, two other areas are needed. I hope to conduct research in hospitalist communication practices but on a much broader scale with my dissertation. My mission along the way is twofold: practice and grant money. I have consulted with numerous professors who have told me that it is helpful to present a local study and show results when applying for grant dollars. I’ve also realized that interviewing is very difficult. In listening to some of my first audiotapes, I talked and talked… Some of you might listen to the tapes and not have the same reaction, but I did.
Geertz, in his essay “The Interpretation of Cultures,” notes that what prevents us from understanding is not our ignorance or lack of cognition but a lack of familiarity. He also uses the expression, “finding our feet.” (13) Last semester, I was accepted in the doctoral program and knew many more studies were down the road for me. I have long recognized that I needed to know more about the hospitalist profession before I totally embarrassed myself in an interview. So, while this is longer than I meant it to be, I wanted to share a story about my journey toward familiarity:
In searching for more articles/information about the profession, I found an article by a physician. While reading the article, I was also spending time searching for hospitalist internships, which are just beginning to be introduced in medical schools. Since the profession began in 1996, there has been no formal training within the internist’s educational process. In searching, I also found that this physician is the Director of Education for a hospitalist intern program at John’s Hopkins Hospital (Baltimore). I sent him an email last November with all the necessary information and asking if he could send me information about the program and wanting to discuss the program with him. Two weeks ago, I received an email from him apologizing for the delay and asking if I still wanted to visit with him. It took us about a week to connect, and we had a 30 minute visit. From the visit I realized that some fundamental “familiar” areas I had presumed to be correct were slightly skewed. Close but not really. From the visit, he has faxed me a brochure, sent an email to a graduate of the program asking if she would contact me, given me suggestions as to funding sources, and opened the door to research at his hospital.
In my journey, familiarity has had a ripple effect, and I realize that this visit is just the beginning. Maybe later I'll share about being prepared. In the first few phone calls, his assistant had led me to understand that he might meet with me at a conference, etc. (in other words, possibly never) and his scheduled was packed. So, when I called and she said, "please hold, he can talk with you NOW" I had a minimal amount of paper - what a hoot in trying to read my notes left to right, up one side and down the other, etc.
Thanks for reading,
Debra
Sunday, February 8, 2009
IRB Journey - didn't know this was going to be such a journey!
Just a little intro - Dr. Eaton is very thorough and as she reviewed my memo to my original IRB, she discovered that the original IRB had some issues. So, I wrote a completely new IRB incorporating the first IRB with my amended IRB for this class project. However, as in all projects, while they may seem more time consuming than expected, I learned about the details of the IRB process and how to write an "expedited" review rather than an "exempt" review.
Debra Burleson
Documentation Practices of Hospitalists
Dr. Amy Koerber is my PI for this study. I will be interviewing hospitalists and medical personnel/ administrators who are employed by hospitals and work with hospitalists from the McLennan and Bell County area. Hospitalists are medical doctors, usually internists, who only treat patients after they are admitted to a hospital.
I. Rationale:
My overall focus is to study the communication practices of hospitalists. In order to be familiar with the profession, it is important that I understand the challenges hospitalists face as they communicate with patients in a hospital setting and also patients’ families. I also want to study hospitalist communication practices by specifically gathering information about their documentation practices involving patient information. Methods from ethnography will be used for this study. The focus of this research is the hospitalists’ documentation practices of patient records during the patient’s hospitalization. These records are very important as they are used by the patient’s primary care physician and other specialists after discharge as well as by hospitalists and medical personnel for inpatient care. I will also ask questions that help clarify the internal communication between administrators/personnel and hospitalists.
Research has shown two significant areas that are of concern to the medical profession: fragmentation of care and patient safety, specifically regarding electronic medical records. As Lee Hock states in his 2008 article, “The increasing complexity of healthcare is accelerating the rate of specialisation in medicine, which in turn aggravates the fragmentation of care in hospitals.” Moore notes that of the outpatient workups recommended by hospitalists, only 45.6% of the cases had written documentation for the primary care physicians.All interviews will either be videotaped or audiotaped so that the researcher can transcribe and analyze their procedures but also use a “think out loud” protocol to capture their thought processes as they write. Videotaping is preferred for the hospitalist interviews, and the only exception would be if videotaping is not possible due to location of the interview. In that case, the interview would be audiotaped. “Think out loud” protocols record the process as well as results. This protocol allows the participant to think through—audibly—word choices which allows the researcher to document the process.
Subjects
(a) Hospitalists at hospitals from the McLennan and Bell counties will be contacted.
(b) Primary Care Physicians who have hospital privileges at the hospitals where hospitalists practice may also be interviewed.
(c) Hospital personnel and administrators who work with hospitalists at the hospital regarding documentation of patient records.
I will contact these professionals either by telephone or email, depending on the preferred mode of communication the hospital administrator(s) prefer. Upon administrator approval, an email will be sent to the administrator who will then forward it directly to the hospitalists and nurses. The email will contain:
· the research process
· my contact information
· overview of the questions
· request for interview times and days
Once the professionals contact me, I will send them:
· specific time and day for the interview based on their information from previous email
· the location of the interview will be at the hospital site
· approval of additional interview or email communication depending on the direction of the research or further explanation of information from the interviews
· specific questions that will be asked during the interview
· length of interview will be approximately 30-60 minutes, depending on the response to questions
· hospitalists will arrange a time when they will be reviewing/charting patient records
· notification that the interviews will be either audiotaped or videotaped
Scripts are located in Appendix A.
Procedures
(a) I will contact individual hospital administration departments by telephone to discuss the research project. Should they agree to be part of the research, they have two options: give my information to the hospitalists so that they can contact me, or give me the hospitalists email or phone number and name so that I can contact them.
Each individual will know that interviews will be audiotaped or videotaped. I will tell them that I’m audiotaping or videotaping the interviews for my purpose only in order to accurately transcribe the information. While recording, I may take notes.
(b) The hospitalists, nurses, hospital personnel and administrators who agree to be part of the study will be given pseudonyms to protect their identity. If I directly quote them, I will use a pseudonym. The name of the hospital will also not be specified.
(c) The benefit to each person interviewed is the result of the research. There will be no compensation.
Adverse Events and Liability
The aim of the research is not to evaluate the hospital, administrators, or hospitalists. It is also not the aim to suggest improvements. Overall, the relatively new profession of the hospitalist has received positive feedback. The aim of the research is to identify practices used by these professionals, methods of delivery, and their perspectives of successes and improvements needed.
As this is a qualitative study, I will guide the direction of the questions. The information solicited is seeking generalized information. Any remarks made that might be detrimental to the hospital, administrators, hospitalists, or nurses will be noted as anonymous.
Consent Form is located in Appendix B
Appendix A
Script of initial introduction with each subject in a Face-to-Face Interview:
The following is a sample of questions I will ask each person I interview. As this is a qualitative study, additional questions may be asked as the interview progresses.
Thank you for meeting with me and participating in this study.
This study is focusing on the documentation practices as you write patient summaries that will be communicated to primary care physicians and other specialists. Questions will not be asked that require you to critique the hospital, nurses, or your administrators. My questions are for information in understanding the processes you use, the wording you choose, and the information you write about the patient. Just a reminder that I’m audio/video taping today’s interview to make sure that my notes are accurate.
If, however, at any time you wish to stop the interview or wish to skip a question, that is perfectly fine. I appreciate your willingness to meet with me. I will need you to sign the consent form I have brought today before we begin.
Script of Face-to-Face Interview Questions with the Hospitalists concerning communication practices:
Were you specifically trained to be a hospitalist in medical school or did you make that choice after graduation?
[If they were trained in medical school…then ask the following question]
2 a. What training prepared you to communicate with the patient?
[If they were not trained in medical school…then ask the following question]
2 b. What factors made you decide on this profession?
How do you define effective doctor/patient communication?
Do you feel that hospitalists need to be better communicators with patients than a patient’s primary care physician?
Every field has expectations that were not apparent when first explored. Was there an interesting part of this profession that you were not aware of—either negative or positive? Please elaborate.
Please compare the care you give your patients as a hospitalist to the care you would give them in the hospital as their primary care physician.
From your perspective, what are the benefits of being a hospital physician as opposed to a primary care physician? What are the negatives? Please elaborate.
If you could equip yourself or train someone else before entering this profession, what areas regarding physician/patient/family relationship would you include in the training?
Do you communicate with friends in other hospitals and other locations who are in this profession? Please elaborate.
In reading research about your profession, many articles cite that patients have a shorter hospital stay under the care of a hospitalist. Have you found this to be consistent with patients under your care?
[If yes, answer #11, if not, move on to #12]
If so, what factors do you think contribute to this?
Do you have concerns about your profession?
Do your patients ever contact you after they are discharged?
Who pays for your malpractice insurance, benefits, etc.?
Because the patient information you chart will be read by specialists or primary care physicians after the patient is discharged from the hospital, I wanted to ask you about the patient charting process. (hospitalists have been asked to arrange a time with me when they would be charting patient information)
Script of Face-to-Face Interview Questions with the Hospitalists concerning documentation practices:
Are you writing summary papers for discharge or updating the patient’s chart?
What is the process you follow when updating the patient’s information? In other words, do you chart information throughout the day or do you make notes throughout the day and chart the information at the end of your shift?
What previous experiences have you had as a physician before becoming a hospitalist? [if the hospitalist has been a primary care physician, then I will ask the following]
What challenges do you face when recording patient information?
Do you find that you record patient information differently than you would if you were the patient’s primary care physician? In other words, if you were continuing care after discharge, would you choose the same words and/or including the same information?
The remaining questions will flow from the information that the hospitalists provides as well as information audibly shared through the “think out loud” protocol process.
Script of Face-to-Face Interview with the Hospital Administrator:
How many hospitalists does your hospital employ?
Do all of the hospitalists have the same duties? If they vary, please explain.
Have you worked with hospitalists at any other hospitals? If so, do you find different hospitals have different expectations of hospitalists?
Were you a hospital administrator when this hospital began using hospitalists?
Tell me about your perception of the new profession and how you see it has impacted the hospital. Please elaborate.
Script of Face-to-Face Interview with a Nurse:
How long have your worked as a nurse? At this hospital?
What shift do you currently work?
Do you find there is one phrase that describes this profession or is the meaning different depending on the practices of each hospital?
Have you worked with hospitalists? How long would you estimate?
Please recall the first time you heard the term and how was it explained to you?
Communication styles vary from individual to individual. However, overall do you see a difference in the doctor/patient communication styles comparing hospitalists to traditional primary care/specialty physicians?
Research studies show that patients tend to have a reduced hospital stay while under the care of a hospitalist. Do you find this true or not? Please elaborate.
From your perspective, are there differences in working with a hospitalist versus a traditional primary care/specialty physician?
Script of Face-to-Face Interview Questions with the Primary Care Physicians and Specialists who have Professional Privileges at the hospital:
If your patients are hospitalized, do you care for them while they are in the hospital or does a hospitalist care oversee patient care? [if a hospitalist cares for their patients, asked #2; if the PCP cares for the patient, go to #4, skip #6]
What is the process you follow after seeing a patient who has been hospitalized?
Regarding documentation of medical records, what form are these records passed to you? In other words, do you receive paper copies, electronic copies, etc.?
What challenges do you face when recording patient information?
What challenges do you face when obtaining information from the patient’s hospitalization?
Do you find that you record patient information differently than you would if you were the patient’s primary care physician? In other words, if you were continuing care after discharge, would you choose the same words and/or including the same information?
The remaining questions will flow from the information that the hospitalists provides as well as information audibly shared through the “think out loud” protocol process.
Script of Face-to-Face Interview Questions with Medical Personnel who work with the Hospitalists (nurses, nurse managers, lab technicians, etc):
Do you record information on a patient’s chart? If so, continue with questions.
What is the process you follow when updating the patient’s information? In other words, do you record information throughout the day, make notes throughout the day and summary at the end of your shift?
What previous experiences have you had working in a hospital? [If the professional works directly with a hospitalist, how long have they worked with hospitalists?]
What challenges do you face when recording patient information?
Do you find that you record patient information differently than you would you were continuing care after hospitalization? In other words, if you were continuing care after discharge, would you choose the same words and/or including the same information?
The remaining questions will flow from the information that the hospitalists provides as well as information audibly shared through the “think out loud” protocol process.
Appendix B
Consent Form:
I am Ms. Debra Burleson, Ph.D. student in Technical Communication & Rhetoric, and I will answer any questions you have about the study. For questions about your rights as a subject or about injuries caused by this research, contact the Texas Tech University Institutional Review Board for the Protection of Human Subjects, Office of Research Services, Texas Tech University, Lubbock, Texas 79409. Or you can call (806) 742-3884.
If at any time you wish to stop the interview or wish to skip a question, please let me know. As I am not employed by this hospital nor receive any compensation from this hospital, there is no penalty or loss of benefits for refusing to participate. I appreciate your willingness to meet with me. I want you to know that I will be using pseudonyms in order to protect the information you share with me, and I will also not divulge the name of the hospital in my research findings. The purpose of this study is not to specifically study this hospital, but to understand the communication and documentation practices of professionals in your field, the implications of those decisions, and to assist me in future studies about the handoff of information to/from the hospitalist to the patient’s primary care physician or specialist.
I may need to contact you after this interview in order to clarify the information from our interview or ask additional questions. You also have the option to not answer any follow-up questions.
I will either videotape or audiotape our discussions in order to authenticate my notes. These tapes will not available to the public and will be kept in a locked cabinet in my office. They are to insure the accuracy of my research.
_____________________________________
Signature of Participant Date
_____________________________________
Signature of Researcher Date
Debra Burleson
Documentation Practices of Hospitalists
Dr. Amy Koerber is my PI for this study. I will be interviewing hospitalists and medical personnel/ administrators who are employed by hospitals and work with hospitalists from the McLennan and Bell County area. Hospitalists are medical doctors, usually internists, who only treat patients after they are admitted to a hospital.
I. Rationale:
My overall focus is to study the communication practices of hospitalists. In order to be familiar with the profession, it is important that I understand the challenges hospitalists face as they communicate with patients in a hospital setting and also patients’ families. I also want to study hospitalist communication practices by specifically gathering information about their documentation practices involving patient information. Methods from ethnography will be used for this study. The focus of this research is the hospitalists’ documentation practices of patient records during the patient’s hospitalization. These records are very important as they are used by the patient’s primary care physician and other specialists after discharge as well as by hospitalists and medical personnel for inpatient care. I will also ask questions that help clarify the internal communication between administrators/personnel and hospitalists.
Research has shown two significant areas that are of concern to the medical profession: fragmentation of care and patient safety, specifically regarding electronic medical records. As Lee Hock states in his 2008 article, “The increasing complexity of healthcare is accelerating the rate of specialisation in medicine, which in turn aggravates the fragmentation of care in hospitals.” Moore notes that of the outpatient workups recommended by hospitalists, only 45.6% of the cases had written documentation for the primary care physicians.All interviews will either be videotaped or audiotaped so that the researcher can transcribe and analyze their procedures but also use a “think out loud” protocol to capture their thought processes as they write. Videotaping is preferred for the hospitalist interviews, and the only exception would be if videotaping is not possible due to location of the interview. In that case, the interview would be audiotaped. “Think out loud” protocols record the process as well as results. This protocol allows the participant to think through—audibly—word choices which allows the researcher to document the process.
Subjects
(a) Hospitalists at hospitals from the McLennan and Bell counties will be contacted.
(b) Primary Care Physicians who have hospital privileges at the hospitals where hospitalists practice may also be interviewed.
(c) Hospital personnel and administrators who work with hospitalists at the hospital regarding documentation of patient records.
I will contact these professionals either by telephone or email, depending on the preferred mode of communication the hospital administrator(s) prefer. Upon administrator approval, an email will be sent to the administrator who will then forward it directly to the hospitalists and nurses. The email will contain:
· the research process
· my contact information
· overview of the questions
· request for interview times and days
Once the professionals contact me, I will send them:
· specific time and day for the interview based on their information from previous email
· the location of the interview will be at the hospital site
· approval of additional interview or email communication depending on the direction of the research or further explanation of information from the interviews
· specific questions that will be asked during the interview
· length of interview will be approximately 30-60 minutes, depending on the response to questions
· hospitalists will arrange a time when they will be reviewing/charting patient records
· notification that the interviews will be either audiotaped or videotaped
Scripts are located in Appendix A.
Procedures
(a) I will contact individual hospital administration departments by telephone to discuss the research project. Should they agree to be part of the research, they have two options: give my information to the hospitalists so that they can contact me, or give me the hospitalists email or phone number and name so that I can contact them.
Each individual will know that interviews will be audiotaped or videotaped. I will tell them that I’m audiotaping or videotaping the interviews for my purpose only in order to accurately transcribe the information. While recording, I may take notes.
(b) The hospitalists, nurses, hospital personnel and administrators who agree to be part of the study will be given pseudonyms to protect their identity. If I directly quote them, I will use a pseudonym. The name of the hospital will also not be specified.
(c) The benefit to each person interviewed is the result of the research. There will be no compensation.
Adverse Events and Liability
The aim of the research is not to evaluate the hospital, administrators, or hospitalists. It is also not the aim to suggest improvements. Overall, the relatively new profession of the hospitalist has received positive feedback. The aim of the research is to identify practices used by these professionals, methods of delivery, and their perspectives of successes and improvements needed.
As this is a qualitative study, I will guide the direction of the questions. The information solicited is seeking generalized information. Any remarks made that might be detrimental to the hospital, administrators, hospitalists, or nurses will be noted as anonymous.
Consent Form is located in Appendix B
Appendix A
Script of initial introduction with each subject in a Face-to-Face Interview:
The following is a sample of questions I will ask each person I interview. As this is a qualitative study, additional questions may be asked as the interview progresses.
Thank you for meeting with me and participating in this study.
This study is focusing on the documentation practices as you write patient summaries that will be communicated to primary care physicians and other specialists. Questions will not be asked that require you to critique the hospital, nurses, or your administrators. My questions are for information in understanding the processes you use, the wording you choose, and the information you write about the patient. Just a reminder that I’m audio/video taping today’s interview to make sure that my notes are accurate.
If, however, at any time you wish to stop the interview or wish to skip a question, that is perfectly fine. I appreciate your willingness to meet with me. I will need you to sign the consent form I have brought today before we begin.
Script of Face-to-Face Interview Questions with the Hospitalists concerning communication practices:
Were you specifically trained to be a hospitalist in medical school or did you make that choice after graduation?
[If they were trained in medical school…then ask the following question]
2 a. What training prepared you to communicate with the patient?
[If they were not trained in medical school…then ask the following question]
2 b. What factors made you decide on this profession?
How do you define effective doctor/patient communication?
Do you feel that hospitalists need to be better communicators with patients than a patient’s primary care physician?
Every field has expectations that were not apparent when first explored. Was there an interesting part of this profession that you were not aware of—either negative or positive? Please elaborate.
Please compare the care you give your patients as a hospitalist to the care you would give them in the hospital as their primary care physician.
From your perspective, what are the benefits of being a hospital physician as opposed to a primary care physician? What are the negatives? Please elaborate.
If you could equip yourself or train someone else before entering this profession, what areas regarding physician/patient/family relationship would you include in the training?
Do you communicate with friends in other hospitals and other locations who are in this profession? Please elaborate.
In reading research about your profession, many articles cite that patients have a shorter hospital stay under the care of a hospitalist. Have you found this to be consistent with patients under your care?
[If yes, answer #11, if not, move on to #12]
If so, what factors do you think contribute to this?
Do you have concerns about your profession?
Do your patients ever contact you after they are discharged?
Who pays for your malpractice insurance, benefits, etc.?
Because the patient information you chart will be read by specialists or primary care physicians after the patient is discharged from the hospital, I wanted to ask you about the patient charting process. (hospitalists have been asked to arrange a time with me when they would be charting patient information)
Script of Face-to-Face Interview Questions with the Hospitalists concerning documentation practices:
Are you writing summary papers for discharge or updating the patient’s chart?
What is the process you follow when updating the patient’s information? In other words, do you chart information throughout the day or do you make notes throughout the day and chart the information at the end of your shift?
What previous experiences have you had as a physician before becoming a hospitalist? [if the hospitalist has been a primary care physician, then I will ask the following]
What challenges do you face when recording patient information?
Do you find that you record patient information differently than you would if you were the patient’s primary care physician? In other words, if you were continuing care after discharge, would you choose the same words and/or including the same information?
The remaining questions will flow from the information that the hospitalists provides as well as information audibly shared through the “think out loud” protocol process.
Script of Face-to-Face Interview with the Hospital Administrator:
How many hospitalists does your hospital employ?
Do all of the hospitalists have the same duties? If they vary, please explain.
Have you worked with hospitalists at any other hospitals? If so, do you find different hospitals have different expectations of hospitalists?
Were you a hospital administrator when this hospital began using hospitalists?
Tell me about your perception of the new profession and how you see it has impacted the hospital. Please elaborate.
Script of Face-to-Face Interview with a Nurse:
How long have your worked as a nurse? At this hospital?
What shift do you currently work?
Do you find there is one phrase that describes this profession or is the meaning different depending on the practices of each hospital?
Have you worked with hospitalists? How long would you estimate?
Please recall the first time you heard the term and how was it explained to you?
Communication styles vary from individual to individual. However, overall do you see a difference in the doctor/patient communication styles comparing hospitalists to traditional primary care/specialty physicians?
Research studies show that patients tend to have a reduced hospital stay while under the care of a hospitalist. Do you find this true or not? Please elaborate.
From your perspective, are there differences in working with a hospitalist versus a traditional primary care/specialty physician?
Script of Face-to-Face Interview Questions with the Primary Care Physicians and Specialists who have Professional Privileges at the hospital:
If your patients are hospitalized, do you care for them while they are in the hospital or does a hospitalist care oversee patient care? [if a hospitalist cares for their patients, asked #2; if the PCP cares for the patient, go to #4, skip #6]
What is the process you follow after seeing a patient who has been hospitalized?
Regarding documentation of medical records, what form are these records passed to you? In other words, do you receive paper copies, electronic copies, etc.?
What challenges do you face when recording patient information?
What challenges do you face when obtaining information from the patient’s hospitalization?
Do you find that you record patient information differently than you would if you were the patient’s primary care physician? In other words, if you were continuing care after discharge, would you choose the same words and/or including the same information?
The remaining questions will flow from the information that the hospitalists provides as well as information audibly shared through the “think out loud” protocol process.
Script of Face-to-Face Interview Questions with Medical Personnel who work with the Hospitalists (nurses, nurse managers, lab technicians, etc):
Do you record information on a patient’s chart? If so, continue with questions.
What is the process you follow when updating the patient’s information? In other words, do you record information throughout the day, make notes throughout the day and summary at the end of your shift?
What previous experiences have you had working in a hospital? [If the professional works directly with a hospitalist, how long have they worked with hospitalists?]
What challenges do you face when recording patient information?
Do you find that you record patient information differently than you would you were continuing care after hospitalization? In other words, if you were continuing care after discharge, would you choose the same words and/or including the same information?
The remaining questions will flow from the information that the hospitalists provides as well as information audibly shared through the “think out loud” protocol process.
Appendix B
Consent Form:
I am Ms. Debra Burleson, Ph.D. student in Technical Communication & Rhetoric, and I will answer any questions you have about the study. For questions about your rights as a subject or about injuries caused by this research, contact the Texas Tech University Institutional Review Board for the Protection of Human Subjects, Office of Research Services, Texas Tech University, Lubbock, Texas 79409. Or you can call (806) 742-3884.
If at any time you wish to stop the interview or wish to skip a question, please let me know. As I am not employed by this hospital nor receive any compensation from this hospital, there is no penalty or loss of benefits for refusing to participate. I appreciate your willingness to meet with me. I want you to know that I will be using pseudonyms in order to protect the information you share with me, and I will also not divulge the name of the hospital in my research findings. The purpose of this study is not to specifically study this hospital, but to understand the communication and documentation practices of professionals in your field, the implications of those decisions, and to assist me in future studies about the handoff of information to/from the hospitalist to the patient’s primary care physician or specialist.
I may need to contact you after this interview in order to clarify the information from our interview or ask additional questions. You also have the option to not answer any follow-up questions.
I will either videotape or audiotape our discussions in order to authenticate my notes. These tapes will not available to the public and will be kept in a locked cabinet in my office. They are to insure the accuracy of my research.
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Signature of Participant Date
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Signature of Researcher Date
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