title: Improving Escalation of Care: Development and Validation of the Quality of Information Transfer Tool.
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.
authors.affiliation: *Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, London, UK †Department of Surgery and Cancer, London, UK ‡School of Medicine, London, UK §Centre for Health Policy, Imperial College London, London, UK.
authors.forename: Maximilian J
authors.initials: MJ
authors.lastname: Johnston
authors.forename: Sonal
authors.initials: S
authors.lastname: Arora
authors.forename: Philip H
authors.initials: PH
authors.lastname: Pucher
authors.forename: Yannis
authors.initials: Y
authors.lastname: Reissis
authors.forename: Louise
authors.initials: L
authors.lastname: Hull
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Huddy
authors.forename: Dominic
authors.initials: D
authors.lastname: King
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education*; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D007407:Interviews as Topic; D008131:London; D062209:Patient Handoff; D011183:Postoperative Complications / Q000628:therapy*; D011787:Quality of Health Care; D012017:Referral and Consultation