As sited by the Institute of Medicine in a 2012 report, the average elderly patient sees seven physicians across four different practices each year.[1]Additionally, IOM reports that the average surgery patient is seen by 27 different healthcare providers while at the hospital, and for a single patient undergoing a procedure, the intricate network of providers may have hundreds of communications over the planning, operation, and post-op period.[2]The increased complexity of patient care is due to the increasing specialization within medicine – generally, a good and necessary innovation – but it also leads to both patients and care team members struggling to keep track of information and knowledge. As discussed in our blog posts on medication errors, the importance of good communication between departments, within departments, and between physicians and patients is critical to the wellbeing of all members involved. Where can communication be improved in hospitals and how? Read on to learn where and how opportunities for miscommunication can (and must be!) eliminated.

 

Communication among the care team

Communication between healthcare workers is critical for the successful flow of information – about 50% of information requests by clinicians were met by colleagues rather than by documented sources – and when there are errors in that communication, there is substantial chance of morbidity and mortality.[3]However, doctors and nurses work in a highly interruptive environment, which can interfere with their ability to work effectively and remember to complete important tasks or give important information.[4]One such interruption can be when one healthcare team member wishes to speak with another and seeks this person out while they are occupied with another task. Though many prefer this two-way communication, either face-to-face or on the phone, it can cause the previously occupied member to forget what they were thinking and doing right before the interruption.[5]Asynchronous methods of communication – such as emails, handwritten notes, or texts – can often be just as effective and can also be used to set up a time to communicate in person without interrupting anyone’s work, therefore limiting errors.[6]

To further improve the effectiveness of communication between hospital staff members, hospitals can develop handoff protocols and train medical professionals in the handoff process.[7]When a patient is moving between departments of a hospital or out of the OR, there is often friction between professionals who have different department loyalties, jargon, and training.[8]Therefore, having more standardized procedures – as well as cross-training employees – can lead to more open, consistent, and frequent communication. Additionally, asking questions to check understanding and encouraging the other healthcare professional to ask questions of you is an important way to increase positive, helpful dialogue; strategically framing questions or even offering a simple pause can make a huge difference.[9]

 

Communication between the care team and their patients

Healthcare professionals cannot attribute all difficulties in communication to the system’s increased complexity; physicians themselves need to be more proactive and improve their listening skills when in consultation with patients. One study found that physicians interrupted patients’ initial statements 77% of the time, and that the average time to interruption by these physicians was a mere 18 seconds.[10]It’s estimated that $765 billion of healthcare spending in 2010 was wasted, with more than half ascribed to unnecessary and inefficiently-delivered services and missed prevention opportunities, and while this cannot be wholly attributed to poor communication, it clearly plays a significant role.[11]

 

Rush University Medical Center in Chicago recently saw significant improvements in patient-physician communication through the implementation of best practices checklists, mandatory afternoon rounds to update patients, patient feedback on the effectiveness of communication, and increased incentives and education for employees on the topic.[12]Furthermore, hospital “facecards” that included a photograph, description of the professional’s role, and contact information are given to each patient to initiate conversation. These are efforts that all hospitals could use to decrease the chances of morbidity and mortality related to miscommunication or a general lack of it.

 

In order to combat the serious dangers that can result from communication deficiencies within a group of medical professionals or between team members and patients, hospitals need to take note of methods that can ease communication difficulties in this increasingly complex system. In order to insure the best treatment possible, communication and teamwork must be valued; only then will a hospital and staff be able to function at their best.

[1]Gordon, Jonathan, Emme Deland, and Robert Kelly, “Let’s talk about improving communication in healthcare,” Columbia Medical Review, June 22, 2015, https://medicalreview.columbia.edu/article/communication-healthcare/

[2]Ibid

[3]Parker, Julie and Enrico Coiera, “Improving Clinical Communication,” Journal of American Medical Informatics Association, Sept-Oct. 2000, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC79040/

[4]Ibid

[5]Ibid

[6]Ibid

[7]Rodak, Sabrina, “5 Top Strategies to Improve Communication in Hospital Operating Room Handoffs,” Becker’s Hospital Review, Dec. 15, 2011, http://www.beckershospitalreview.com/or-efficiencies/5-top-strategies-to-improve-communication-in-hospital-operating-room-handoffs.html

[8]Ibid

[9]Ibid

[10]Gordon, Deland, and Kelly, “Let’s talk”

[11]Ibid

[12]Dutta, Suparna, Francis Fullam, and Jay M. Behel, ”How We Improved Hospitalist-Patient Communication,” NEJM Catalyst, Feb. 5, 2017, http://catalyst.nejm.org/how-we-improved-hospitalist-patient-communication/