By Jonathan Springston, Editor, Relias Media
To better understand and potentially improve communication between physicians and nurses, researchers recently used video to record interactions. Physicians and nurses later viewed and evaluated the footage individually and then together.
“Despite decades of research and interventions, poor communication between physicians and nurses continues to be a primary contributor to adverse events in the hospital setting and a major challenge to improving patient safety,” the authors lamented. “The lack of progress suggests that it is time to consider alternative approaches with greater potential to identify and improve communication than those used to date.”
During this small pilot study, investigators discovered that nurses often hesitated to ask physicians follow-up questions or push for clarifications on physician decisions. Further, researchers noted that physicians and nurses approach their duties differently, which can lead to more misunderstandings. The study authors also observed that muddled communication and strained relationships between physicians and nurses even leads to poor body language.
The study authors concluded that video recordings and subsequent viewing and discussion “did generate increased reflection in both nurse and physician participants. Moreover, [this process] has utility in assessing communication and, based on the comments of our participants, can serve as an intervention to possibly improve communication, with implications for patient safety.” The authors added that this technique could be expanded and used in larger facilities to not only improve staff communication but also quality and safety practices.
Communication in healthcare is a subject of frequent discussion in Relias Media publications. In the April issue of ED Management, author Dorothy Brooks wrote about a mobile app that one community hospital in New Jersey uses to improve communication between EMS providers and ED staff. Prehospital providers use the app to notify the ED electronically that a patient is on the way, along with any key clinical information. The approach replaces the need for phone or radio notifications, which can tie up ED-based staff or get missed when the ED is busy.
An article in the June issue of ED Management spotlighted hospitals that use safety huddles effectively. These facilities not only improved overall communication among staff but improved in other areas such as hand hygiene compliance and patient experience scores.
Documentation, a critical form of nonverbal communication in healthcare, could make or break a malpractice case. In the September issue of ED Legal Letter, author Stacey Kusterbeck noted one instance in which an ED patient was very specific during the nursing evaluation of his chest pain: It worsened during exertion. The patient also reported an extensive family history of cardiac problems. Both worrisome pieces of information were carefully documented in the ED nursing notes. However, they were mentioned nowhere in the emergency physician’s documentation. This became a key issue during malpractice litigation.
Good communication between healthcare professionals and patients is just as important. In the August issue of Case Management Advisor, author Melinda Young discovered case managers can improve communication by including patients more during transitions.
“Case managers are in a good position to advocate for patients, but they need information about what the patient wants — as well as what health providers want for the patient. The way to find out what they want is to develop a rapport with patients and listen to what they say they need,” Young wrote. “This is especially important when patients have not spelled out their decisions and plans in advance directives.”
Recordings also can be useful when deciding if a patient is exaggerating a complaint, as noted in the September issue of Hospital Access Management. In one facility, leaders use random recordings of interactions between patient access staff and patients to identify areas for education and improvement.
“Occasionally, a patient accuses someone in the department of acting overly aggressive with collecting. Sometimes, the complaint is about rude treatment. In the past, this was a ‘he said/she said’ situation, but it is no longer a mystery for leadership,” one leader explained. “The emphasis is on providing the best possible service for patients. Employees also realize they are protected from unfounded complaints.”