Multiple studies indicate that ineffective communication among health care professionals is one of the leading causes of medical errors and patient harm.[1]
A review of reports from the Joint Commission reveals that communication failures were at the root of over 70 percent of sentinel events.[2] A CRICO Strategies Study showed that communication failures were linked to 1,744 patient deaths over five years.[3] And a study from the University of California, San Francisco, showed that more than 25% of hospital readmissions could be avoided with better communication among healthcare teams and between providers and patients.
Here are 5 ways to address communication as it relates to patient safety.
1. Foster teamwork
When clinical and non-clinical staff communicate and collaborate effectively, outcomes improve, medical errors go down, and patient satisfaction rises. What is your organization doing to cultivate safer more effective teams? If you’re looking for evidence-based training materials and tools, here are several resources developed by national organizations:
- TeamSTEPPS®. Developed by the Agency for Healthcare Research and Quality (AHRQ) and the U.S. Department of Defense, this evidence-based set of teamwork tools is focused on optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals. The curriculum focuses on four core teamwork competencies: communication, leading teams, situation monitoring and mutual support. The TeamSTEPPS website offers free in-person and online training courses, materials, videos and recorded webinars.
- American Hospital Association (AHA) Tools. The AHA’s Health Research & Educational Trust (HRET) and American Organization of Nurse Executives (AONE) offer evidence-based tools and resources on improving communication, teamwork and collaboration, including education and training to implement these tools and foster a culture of safety.
You might also consider innovative training such as medical improv, a type of theater improvisation that uses experiential learning activities to teach healthcare professionals communication and interpersonal skills.
2. Standardize communication handoffs
Many studies point to errors occurring when there is inadequate communication about a patient’s status or condition when there is a provider shift change, or when staff deliver information to physicians. As a result, handoff improvement initiatives have been launched by many health systems over the last several decades as part of creating a culture of patient safety.
There are several handoff methods that have gained traction over the last decade, and their toolkits are available free of charge. SBAR - which stands for Situation, Background, Assessment, Recommendation - was developed by physicians at Kaiser Permanente, and has been widely adopted nationally. SBAR uses a standard set of questions about each patient so all information is communicated completely and clearly. The tool considers the expertise of nurses and other care providers, and provides a framework for them to make recommendations to physicians. In this way, SBAR breaks down historically hierarchical communication structures. An SBAR implementation toolkit is available on the Institute for Healthcare Improvement (IHI) website.
I-PASS, used by Harvard Medical School and others, is another successful bundled communication and training tool system for improving patient handoffs. As reported in a New England Journal of Medicine article, injuries due to medical errors decreased by 30% in a multicenter study at Boston Children’s Hospital.
3. Implement daily huddles
Huddles are one of the best ways to update everyone in real-time, minimize distractions throughout the day, and create a daily opportunity for physicians and care teams to discuss what they anticipate for each patient that day. In short, a huddle involves a unit care team meeting for about five minutes to report out their metrics, discuss how they did the day prior, and focus on what was learned. The team also discusses what can be anticipated with patients under the unit’s care throughout the upcoming day. In many organizations, various executives attend the huddle as well.
After testing huddles in multiple hospitals and surgery centers, IHI researchers and organizational leaders found that they were effective because they help keep everyone focused on quality improvement goals.[4]
4. Involve families
Engaging patients and families in the care and communication process is becoming more common as patient experience scores take on increased importance. Plus, some research shows a correlation between increased patient and family engagement and fewer adverse events.
How a patient and his or her family is integrated into the communication process is unique to each patient’s family support circumstance, cultural background, and cognitive abilities, which can be compromised by medication or their acute condition. The key is to ask patients and families how they want to be involved and engage appropriately in care plan design, status updates, and discharge preparation.
5. Develop a clear escalation procedure
Even when standard communication protocols are in place and your teams are functioning well, patient status can change quickly and unexpectedly. In those cases, it’s essential that your organization have a defined procedure for escalating the issue to the right individuals at the right time. This is particularly critical for large and academic organizations in which there are typically multiple layers and multiple physicians - from attendings to residents to fellows - participating in patient care. Rapid Response Teams are one method for quick response when a patient’s condition deteriorates. The IHI provides an online toolkit and implementation resources for implementing Rapid Response Teams here.
[1] Improving Patient Safety Through Provider Communication Strategy Enhancements, Catherine Dingley RN, PhD, FNP; Kay Daugherty RN, PhD; Mary K. Derieg RN, DNP; Rebecca Persing, RN, DNP, AHRQ, See references 1, 2, 3.
[2] Joint Commission on Accreditation of Healthcare Organizations. 2005 National Patient Safety Goals. Accessed February 6, 2008.
[3] Communication Failures linked to 1,744 Deaths in Five Years, US Malpractice Study Finds, Melissa Bailey, STAT News, February 1, 2016
[4] Huddle Up: Why daily meetings are vital to Sustaining Quality Improvement, Becker’s Hospital Review, January 6, 2017
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