Communication: a skill that is innately human and yet so, so difficult to master. Effective communication requires recognition of context, frame of reference, assumptions, and differing perspectives to understand and deal with a situation. Especially in a medical setting, communication is vital. However, a recent report found that 30% of malpractice cases were the result of communication errors, demonstrating the need to address potentially lethal misunderstandings of medical professionals between departments, within a department, and with patients.1
In the previous article written for this series on medical errors, the focus was on medication errors, which are fairly simple to identify. However, an error like miscommunication is much more complex to manage, especially between departments. One department consistently struggling with communication is the Emergency Department. With the push for higher patient turnover, medical staff in the ED might not always have the time to explain everything clearly to the staff of the unit the patients are sent to. The consequences of this, one study reported, is that miscommunication between caregivers when transferring patients accounts for 80% of serious medical errors.2 Patients are often admitted before their new caretakers have the opportunity to go through the patients’ charts or even determine if they’ve been sent to the proper unit. It’s in these in-between stages that misdiagnoses can occur, or crucial tests, medication needs, and irregular conditions can be overlooked.
An example was the recent handoff between the ER and medical surgical floor when the patient’s vital signs were reported as normal. When the nurse then received her patient she thankfully took a full set of vitals, only to find a very low temperature of 34 degrees Celsius (93.2 Fahrenheit); thankfully this patient was appropriately managed with a warming device. Of concern however is when did a full set of vitals upon a hospital admission not include pulse, respiration, blood pressure as well as temperature? While this example can fortunately be considered fairly innocuous, ask any health care provider and they will likely have numerous examples of failure to communicate with potential for patient declining status.
An example of miscommunication with devastating consequences was with a patient who was transferred from a LTC facility to a local ER for infection. When the patient returned to the LTC facility, she returned with an antibiotic prescription that was never filled. This apparent oversight resulted in the patient’s decline and subsequent diagnosis of sepsis and death.
Another example of the potential for communication oversights is when patients are sent to Radiology or a Special Procedures Unit. Though the healthcare providers in those departments have access to the patients’ electronic charts, many times they don’t receive reports on the patients. If something were to happen to a patient while they were in one of these units, it’s likely that the providers might not know how to proceed due to the fact that they aren’t familiar with the patient’s condition or current treatment. Without that communication between departments, lives hang in the balance.
While these above referenced difficulties between departments can be understandably difficult to manage, what many do not realize is the intense hierarchical nature existing within departments, precluding successful dialogue and communication between nurses and MDs. The next article in this series will focus upon this topic.