Communication Challenges Affect Discharge Planning
By Melinda Young
Obstacles to effective care transitions include communication problems, both inside and outside the health system, according to researchers.
- When providers were asked about their communication concerns, they cited too many methods of communication, a high volume of communication, and challenges communicating with multiple providers and those outside their health system.
- When case managers and nurses send messages to physicians, they need to know which method of communication works best for each provider.
- Health systems need to set a standardized communication method, and case managers can find out what each provider outside of the health system prefers.
Providers report care transition concerns regarding communication both within the system and outside of the health system, according to a recent study.1
From the perspective of a surgical oncologist treating patients with gastrointestinal cancers, a major challenge is communicating with the other providers involved in each patient’s care, says Eliza W. Beal, MD, lead study author and an assistant professor in the Barbara Ann Karmanos Cancer Institute at the Wayne State University School of Medicine in Detroit.
“We were interested in looking at how specialists communicate with primary care providers during and after treatment,” Beal explains. “We were interested in how providers communicate about patients in the hospital.”
It is important for providers to plan communication because they do not often see each other at the bedside, Beal says.
The four main concerns are:
- Too many methods of communication;
- A high volume of communication;
- Challenges with the involvement of multiple providers handling multitudinal care;
- Difficulty communicating with providers outside the health system.
Conversations about patients can take place via cellphones, networked hospital phone lines, landlines, email, in-basket messaging, secure chats, charts, Microsoft Teams, faxes, and others, Beal says. “That’s a lot of different ways to communicate,” she adds.
Providers, case managers, and others involved in care transitions and discharge planning could miss vital information if they do not monitor all the various ways people are communicating with them. Hospital systems often set their own preferences for secure communication, but this system may not work in every case, especially when dealing with providers outside the health system.
Beal and colleagues talked with providers who offered suggestions about how to improve conversations. One of their common ideas was to create a standardized communication process. “When a patient goes from the ICU to med-surg service and services changes, let’s think how we do the handoff,” she says. “Is it a person or document in the health record — however standardized?”
Standardizing communication with outside providers is trickier. “Say I’m an oncologist at Wayne State, and I have a relationship with a person at Henry Ford Hospital,” Beal explains. “I call their offices and leave a message, and there’s no easy way for me to email them or get their cellphone number.”
This results in providers sending faxes to other providers. But this also creates uncertainty because there is no way to know if the intended fax recipient saw the message. “You can standardize communication with health systems that work together all the time,” Beal notes. “One suggestion was having an email list of providers in Detroit.”
When case managers and nurses send emails or messages to physicians, they should keep in mind hospital physicians treat many patients. This creates a barrier to effective communication.
“I may have five patients in the hospital, but those taking care of the same patient may see 40 patients,” Beal says. “Time and volume were a big impediment, and someone has to organize it and get buy-in from stakeholders and getting everyone to agree on a plan.”
One tactic is to find out each provider’s preferred method of communication. It could be text message, email, chart notifications, or something else. “One provider said, ‘Communication is in the chart, and people could read the progress notes,’” Beal recalls. “Case managers, therapists, and nurses can read the progress notes and [then] can contact the physician directly.”
Also, each health system sets different communication expectations. For example, an organization could let staff know that everyone is responsible for checking the chart. If someone asks a question, they can provide a contact name and number or email address.
For providers who are not employees of the health system, a standard method of communication may be the fax machine. “The primary way I communicate with outpatient providers is faxed notes,” Beal says. “If I had a list of email addresses, I could email the provider my note.”
Another way to improve communication is to assign someone — maybe a care coordinator, office staff, or case manager — to contact primary care providers.
“Improving standardization is really important,” Beal says. “Say every cancer provider in the health system, when they’re done taking care of a patient, sends a half-page template to the primary care provider, saying, ‘This patient got this procedure, and we’re going to see them every six months. These are the long-term side effects of getting this chemo.’”
It is helpful to primary care providers to know the specialists’ concerns about each patient. They often are the physicians who patients will see most often, Beal notes.
“The patient may be reluctant to drive an hour to see [a specialist] but will walk a block to see their primary care provider,” Beal says.
- Beal EW, Kurien N, DePuccio MJ, et al. Provider-to-provider communication about care transitions: Considering different health technology tools. J Healthc Qual 2023;45:133-139.
Obstacles to effective care transitions include communication problems, both inside and outside the health system, according to researchers. When providers were asked about their communication concerns, they cited too many methods of communication, a high volume of communication, and challenges communicating with multiple providers and those outside their health system.
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