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.

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