Closing communication gaps between providers

by Diane Shannon, MD, MPH

Errors in communication are widely recognized as an important cause of adverse events in health care. In 2010, communication problems were the most commonly cited root cause of sentinel events, according to data reported to the Joint Commission.

In fact, communication issues were identified as a root cause of two thirds of all the sentinel events reported to the Joint Commission since 1995. The organization has estimated that if medical errors were listed among the causes of death in the United States, they would rank fifth—with an incidence higher than accidents, diabetes, Alzheimer’s disease, AIDS, breast cancer, and gunshot wounds.

The Joint Commission recognizes a host of potential negative consequences of ineffective communication, including failure to document critical information, increased length of stay, increased costs, and negative patient perceptions of the health care experience.

Researchers and quality improvement organizations, such as the Institute for Healthcare Improvement and the Agency for Healthcare Research and Quality, have identified a number of interventions that can improve communication among health care providers, including teamwork training and the use of structured communication tools, such as SBAR (Situation-Background-Assessment-Recommendation).

A great deal of attention has been focused on improving patient safety, the quality of care, and clinical integration with the use of these interventions.

Until recently, relatively little attention has been paid to the prevalence and potential consequences of poor communication between physicians. However, a study published in Archives of Internal Medicine in January 2011 found that primary care providers who recounted a lack of timely communication from specialists regarding referrals were more likely to report that their ability to provide high-quality care was threatened.

Here are two common examples of communication issues that put the patient at risk:

  • Obstetrician-Gynecologist Thomas Meyer, MD, recalls a recent case in which he and another specialist were consulted by a primary care physician. “We had to wait to speak with the other consultant, going through his office, waiting for the answering service to reach him, and waiting for him to call back. It definitely caused a delay in trying to coordinate care.”
  • Laila Shehadeh, DO, chief of staff at Henry Ford Macomb Hospital — Warren Campus, said consultants at her hospital are required to address routine consults within 24 hours of the request. “I try to help physicians realize that by talking colleague to colleague you can decrease morbidity and mortality, lengths of stay, and sentinel events. We can’t excuse a longer stay, saying ‘The patient stayed one extra day because we couldn’t reach Dr. Shehadeh.’” she said.

Health care organizations are increasingly focused on improving patient safety and clinical integration. Closing the communication gaps between providers is essential for achieving these goals and helping to meet the ultimate goal of fostering improved patient care.

Diane Shannon is a medical writer and consultant at PerfectServe.

Submit a guest post and be heard on social media’s leading physician voice.

email

Comments are moderated before they are published. Please read the comment policy.

  • Melissa

    “The organization has estimated that if medical errors were listed among the causes of death in the United States, they would rank fifth—with an incidence higher than accidents, diabetes, Alzheimer’s disease, AIDS, breast cancer, and gunshot wounds.”

    I was intrigued by this statement. Where is the original source of this?

    • Diane Shannon

      Thank you for highlighting these data and for your interest in the topic. There are two primary sources for the information (full citations below): The Institute of Medicine’s 1999 report, To Err is Human, and National Center for Health Statistics’ “Death: Final Data for 1997″ in the National Vital Statistics Report, 1997.

      The seminal Institute of Medicine (IOM) report states that based on hospital admissions data from 1997, “at least 44,000 and perhaps as many as 98,000 die in hospitals each year as a result of medical errors.” According to the CDC report, the death rate for the 5th leading cause of death (accidents and adverse effects) was 35.7 per 100,000 in 1997. Based on the total population estimate used for the report (267.6 million), the number of deaths for the 5th rated cause of death was 95,533. Thus, using the higher estimate from the IOM (98,000), medical errors would rate 5th as a cause of death.

      To be more precise, the sentence should read, “According to data from the Institute of Medicine and the National Center for Health Statistics, if medical errors were listed among the causes of death in the United States, they would rank fifth—with an incidence higher than accidents, diabetes, Alzheimer’s disease, AIDS, breast cancer, and gunshot wounds.”

      Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system . Washington, DC: National Academy Press, Institute of Medicine; 1999.

      Centers for Disease Control and Prevention. National Center for Health Statistics. Deaths: final data for 1997. Natl Vital Stat Rep. 1999;47(19):5, 97, 99.

  • http:www.healthcaretownhall.com Jeremy Engdahl-Johnson

    Medical errors research in latest Health Affairs. Society of Actuaries study indicates more than 2 million patient injuries each year. http://www.healthcaretownhall.com/?p=3809

  • http://bethechangemn.com Theresa Zimanske

    Thank you for putting time and attention to the communication aspects of healthcare. Simply
    more reason to have the patient family perspective
    represented on staff to insure the patient centered focus
    is advocated daily.

    Theresa Zimanske, Founder
    Be The Change
    http://bethechangemn.com
    theresazim@charter.net

  • Diane Shannon

    Given the escalating costs associated with health care, it’s clear we can’t continue with the status quo. Reforming our “system” is a major, ground-breaking endeavor. Because we are attempting an enormous change without the benefit of a clear and completely parallel example to follow, the journey is going to include snags. But to improve the quality, safety, and patient-centeredness of care–and avoid bankrupting our country–we need to strive for something better, and quickly.

Most Popular