Article

Quantifying the Economic Impact of Communication Inefficiencies in US Hospitals

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Abstract

Care delivery is a complex enterprise that involves multiple interactions among multiple stakeholders. Effective communication between these dispersed parties is critical to ensuring quality and safety and improves operational efficiencies. Time and motion studies in hospital settings provide strong evidence that care providers-doctors and nurses-spend a significant proportion of their time obtaining or providing information (i.e., communicating). Yet, surprisingly, no studies attempt to quantify the economic waste associated with communication inefficiencies in hospital settings at a national level. Our research focuses on developing models for quantifying the economic burden on hospitals of poor communications. We developed a conceptual model of the effects of poor communications in hospitals that isolates four outcomes: (1) efficiency of resource utilization, (2) effectiveness of core operations, (3) quality of work life, and (4) service quality, identifying specific metrics for each outcome. We developed estimates of costs associated with wasted physician time, wasted nurse time, and increase in length of stay caused by communication inefficiencies across all U.S. hospitals, using primary data collected from interviews in seven hospitals and secondary data from a literature review, the Bureau of Labor Statistics (BLS), and the Agency for Healthcare Research and Quality (AHRQ). We find that U.S. hospitals waste over $12 billion annually as a result of communication inefficiency among care providers. Increase in length of stay accounts for 53 percent of the annual economic burden. A 500-bed hospital loses over $4 million annually as a result of communication inefficiencies. We note that our estimates are conservative as they do not include all dimensions of economic waste arising from poor communications. The economic burden of communication inefficiency in U.S. hospitals is substantial. Information technologies and process redesign may help alleviate some of this burden.

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... Pese a la importancia de todos estos aspectos en la calidad del cuidado y en su efectividad, los estudios que han abordado la relación existente entre actitudes hacia comunicación, IE y empatía son escasos (14)(15) . ...
... Cuestionario sobre actitudes de las enfermeras hacia la comunicación (ACO) (14) Está compuesto por 25 ítems agrupados en tres dimensiones: afectiva, cognitiva y conativa para evaluar las actitudes hacia la comunicación. Dicho instrumento ha mostrado adecuadas propiedades psicométricas (19) . ...
... Según la literatura existente estas variables parecen verse influidas por factores situacionales o variables extrínsecas, más difíciles de controlar por parte de los enfermeros, y los factores disposicionales o variables intrínsecas como son las capacidades personales (14)(15) así variables como el sexo o la edad pueden ser variables que pueden ejercer un papel moderador en estas variables (14) . ...
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Objective: To determine the influence of nurse education and training on attitudes towards communication, emotional intelligence, and empathy. Method: A cross-sectional study was conducted using three separate instruments to measure attitudes towards communication, empathy, and emotional intelligence, and two questions to determine the academic qualifications of the study participants. The effect of the variables was tested using one-way ANOVA, Pearson correlations, and hierarchical multiple linear regression. Results: The study sample comprised 438 nurses from hospitals in Valencia, Spain. Differences in subscale scores of the instruments according to degree level and specialized training were observed, showing that nurses with only a degree and less specialized training had lower capacity for empathy and emotional intelligence. The strongest correlations were found between the factors of the communication dimensions. Multiple linear regression showed that perspective taking and emotional clarity had the greatest predictive power. Conclusion: Degree level and specialized training were shown to influence the study variables and it is therefore necessary to prioritize education and training programs that promote the development of these skills to ensure improved service quality.
... Conversely, in poor communication systems, high-quality patient care, patient satisfaction, collaboration and teamwork and commitment from leaders to provide resources become lost (Timmins, 2011;Vermeir et al., 2015). Unfortunately, health care systems suffer from enormous inadequacies related to poor communication (Agarwal, Sands, & Díaz Schneider, 2010;Gluyas, 2015;Vermeir et al., 2015). ...
... In hospitals across the United States of America, for example, an estimated $12 billion worth of economic waste has arisen from poor communications (Agarwal et al., 2010). Health care staff, as far back as the 90s, have rated communication as an important factor that contributes to a good workplace; it is also consistently rated by practitioners as the workplace factor most in need of improvement (Feather, Ebright, & Bakas, 2014;Horsley, 1996;Tourish & Mulholland, 1997). ...
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Aims The aims of this study were to explore the differences in organisational communication satisfaction between ward paediatric nurses and middle managers, and to assess whether there is a difference in organisational communication satisfaction between paediatric nurses and middle managers with different educational levels, years of nursing and managerial experience, contracted hours, area of work, age and gender. Background Previous studies reported a connection between job satisfaction, work commitment and organisational communication, however, nurses’ and nursing middle managers’ satisfaction with organisational communication has not been extensively studied in recent years and not at all among paediatric nurses. Methods A cross‐sectional quantitative research design using online and hard copy self‐reported questionnaires was used. Data were collected at one point in time from paediatric nurses and middle (nursing) managers working in a tertiary paediatric hospital in Australia. Statistical methods were employed for data analysis. Results The middle management group were significantly more dissatisfied with organisational communication then the paediatric ward nurse group. Middle managers were found in this study to effectively manage and maintain communication lines with the personnel who reported to them, however communication within the management cohort itself was found to be suboptimal. Conclusion Further research to understand how horizontal and vertical communication at the nurse manager and executive level can be optimised is required. Implications for nursing management It is anticipated that the findings from this study may increase the understanding of communication satisfaction between paediatric nurses and middle managers. The study has highlighted the need for improvement with information flow in the management cohort with the addition of extra managerial support and empowerment.
... Communication is crucial to the delivery of patientcentered healthcare [4]. With the transition from a system and culture of medical paternalism to one of shared decision-making and patient autonomy has come the unprecedented importance of effective communication. ...
... *Correspondence: Kevin.seely@rvu.edu 1 College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA Full list of author information is available at the end of the article Adverse health outcomes, compromised safety, and increased economic burden are attributable to communication gaps and the breakdown of physician-patient relationships [4,5]. This is particularly true when considering pre-operative education and informed consent. ...
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The teach-back method is a valuable communication tool that can be employed to improve patient safety and shared decision-making. Its utility in patient care has been studied extensively in many areas of clinical medicine. However, the literature on the use of teach-back in surgical patient education and informed consent is limited. Additionally, there is some ambiguity about the functional definition and performance of the teach-back method in the literature, consequently rendering this valuable tool an enigma. This review examines the current standards and ethics of preoperative informed consent and provides a concise, actionable definition of teach-back. The manner in which teach-back has been implemented in medicine and surgery is then examined in detail. Studies analyzing the use of teach-back in medicine have demonstrated its effectiveness and benefit to patient care. Further study on the use of teach-back to improve preoperative informed consent is supported by the few preliminary trials showing a positive effect after implementing the teach-back method in critical patient interactions.
... Progress in communications and technologies enables this interaction to be carried out remotely using computers or mobile phones; however, effective communication in medical settings remains a major challenge. In situations when the context is more complex and requires greater agility for diagnosis and treatment, collaboration [6][7][8] has been an option to encourage the exchange of experiences in order to increase the chances of positive results [9]. ...
... New concepts contribution ratio = , User participation indicator (9) In the context of the presented methodology, this factor reflects the diagnostic suggestions or contributions. This ratio could help to characterize the participants, i.e., if they are brief in their messages but provide information, or on the contrary, if the texts of their contributions are very broad but do not add new clinical suggestions or information. ...
Article
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The Internet and social media is an enormous source of information. Health social networks and online collaborative environments enable users to create shared content that afterwards can be discussed. The aim of this paper is to present a novel methodology designed for quantifying relevant information provided by different participants in clinical online discussions. The main goal of the methodology is to facilitate the comparison of participant interactions in clinical conversations. A set of key indicators for different aspects of clinical conversations and specific clinical contributions within a discussion have been defined. Particularly, three new indicators have been proposed to make use of biomedical knowledge extraction based on standard terminologies and ontologies. These indicators allow measuring the relevance of information of each participant of the clinical conversation. Proposed indicators have been applied to one discussion extracted from PatientsLikeMe, as well as to two real clinical cases from the Sanar collaborative discussion system. Results obtained from indicators in the tested cases have been compared with clinical expert opinions to check indicators validity. The methodology has been successfully used for describing participant interactions in real clinical cases belonging to a collaborative clinical case discussion tool and from a conversation from a health social network. This work can be applied to assess collaborative diagnoses, discussions among patients, and the participation of students in clinical case discussions. It permits moderators and educators to obtain a quantitatively measure of the contribution of each participant.
... 25 Studies exploring healthcare communication practices have exposed that traditional methods contribute towards untimely reviews and communication bottlenecks associated with increased patient risk and LOS. 17 These procedures were identified as 'non-value adding activities' that were subsequently related to delayed patient care and patient safety implications. 19 Service quality and QWL Synchronous communication practices are associated with increased rates of cognitive workload, burnout and user dissatisfaction. ...
... Qualitative studies exploring healthcare communication practices have exposed that traditional communication methods have contributed to untimely patient reviews and bottlenecks associated with increased patient risk and LOS. 17 On the contrary, process mapping revealed a reduced number of steps and wait periods when using the asynchronous platform, thereby potentially reducing LOS and improving the patient journey. Indeed, delayed patient care including increased LOS, delayed discharge and transfer are shown to have dire patient safety implications. ...
Article
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Background Healthcare systems revolve around intricate relations between humans and technology. System efficiency depends on information exchange that occur on synchronous and asynchronous platforms. Traditional synchronous methods of communication may pose risks to workflow integrity and contribute to inefficient service delivery and medical care. Aim To compare synchronous methods of communication to Medic Bleep, an instant messaging asynchronous platform, and observe its impact on clinical workflow, quality of work life and associations with patient safety outcomes and hospital core operations. Methods Cohorts of healthcare professionals were followed using the Time Motion Study methodology over a 2-week period, using both the asynchronous platform and the synchronous methods like the non-cardiac pager. Questionnaires and interviews were conducted to identify staff attitudes towards both platforms. Results A statistically significant figure (p<0.01) of 20.1 minutes’ reduction in average task completion was seen with asynchronous communication, saving 58.8% of time when compared with traditional synchronous methods. In subcategory analysis for staff: doctors, nurses and midwifery categories, a p value of <0.0495 and <0.01 were observed; a mean time reduction with statistical significance was also seen in specific task efficiencies of ‘To-Take-Out (TTO), patient review, discharge & patient transfer and escalation of care & procedure’. The platform was favoured with an average Likert value of 8.7; 67% found it easy to implement. Conclusion The asynchronous platform improved clinical communication compared with synchronous methods, contributing to efficiencies in workflow and may positively affect patient care.
... By creating strong internal communication systems, an organisation can increase productivity, staff satisfaction, commitment and attachment to the organisation, and high quality patient care ( Batch, 2012 ;Byrne, 2016 ). In contrast, poor communication often results in poor patient outcomes as a result of medical errors, poor staff performance, increased absenteeism, poor collaboration, and teamwork and poor commitment to an organisation ( Agarwal, Sands, and Schneider, 2010 ;Vermeir et al., 2015 ). ...
... Therefore, if an employee is satisfied with the quality of supervisor subordinate relationships, employee recognition and involvement ( Donohue-Porter et al., 2019 ;Pincus, 1986 ), praise and manager practice ( Tourangeau and Cranley, 2006 ), they will be committed to their job and the organisation ( Adrian and Ticehurst, 2001 ;Bartels, Peters, de Jong, Pruyn, and van der Molen, 2010 ;Becker, 1992 ;Brunetto et al., 2011 ;Donohue-Porter et al., 2019 ;Griffeth, Hom, and Gaertner, 20 0 0 ). In contrast, others' work suggests that if an employee is not effectively communicated with by their supervisor or actively involved with the decision-making process, they will become less committed to the organisation in which they work, which results in high turnover and absenteeism rates ( Agarwal et al., 2010 ;Vermeir et al., 2015 ). An Australian study found that by improving relationships with managers, the amount of information being received and the length of time for communications to take place, those effective communication strategies were promoted ( Braff, Manias, Finch, Riley, and Munro, 2012 ). ...
Article
Aims To examine the effect of paediatric nurses’ organisational communication satisfaction on job satisfaction and intention to stay in their role. Background Nurses’ satisfaction with organisational communication has not been studied in-depth in recent years and specifically, there is a paucity of evidence in relation to paediatric nurses’ job satisfaction and intention to stay in their current job. Methods A cross-sectional quantitative research design using questionnaires was used. Descriptive statistics were used to analyse demographic data and structural equation modelling was used to analyse the hypothesised models. Findings The constructs of supervisor relationships, communication climate and media quality had a significant direct effect on paediatric nurses’ job satisfaction. Job satisfaction was found to have a significant negative inverse relationship with intention to leave and looking for another job in nursing. Conclusion Strategies that promote job satisfaction and communication satisfaction should be disseminated by management in order to reduce paediatric nurse intention to leave and looking for another job. Implications for nursing management The study highlighted the need for improvement in the efficacy of communication systems for upward and downward feedback in order to improve supervisor subordinate relationship. Further, managers need to facilitate adequate infiltration of relevant information to maintain low levels of frustration and prevent development of grapevines amongst nurses.
... Still, patients practice deception often (Reddy, 2013). Conservative estimates suggest that communication inefficiencies throughout the U.S. health care system lead to the loss of thousands of lives each year and waste $12 billion annually (Agarwal et al., 2010). Some 55% of these communication inefficiencies occur between patients and health care providers (CRICO Strategies, 2015). ...
... Pertanto, rispetto all'idea radicata che bisogna «difendersi dall'errore per difendersi dalle sue conseguenze» 8 è essenziale acquisire una nuova mentalità centrata sulla prevenzione dell'errore e sulla promozione della formazione sui temi della sicurezza. Le conseguenze, in termini di danno per i pazienti e costi per le strutture, hanno stimolato l'analisi delle criticità metodologiche inerenti il PdC, allo scopo di migliorarne la qualità, l'efficacia e la sicurezza 9 . È indicativo a questo proposito che l'Organizzazione Mondiale della Sanità (OMS-WHO), avendo riscontrato che l'inadeguatezza della comunicazione è responsabile del 25-40% degli EA 10 , abbia inserito nella lista delle "top five patient safety solutions" una serie di indicazioni per migliorare la comunicazione nell'ambito del PdC. ...
Article
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The handover among healthcare professionals has been a topic of increasing interest over recent years. Many studies have shown that ineffective communication during handover can be critical, particularly for anaesthesiologists and intensivists because of the highly complex needs of patients under their care. Numerous studies have identified the information transfer process as the greatest risk of errors and adverse events (AEs), which results in harm to patients, increases legal issues and damages relations between health professionals. The adoption of effective communication methods determines a significant improvement of the handover and a reduction in the frequency of errors and AEs. The purpose of this document is to focus attention on the problem in order to promote heightened safety procedures within health facilities. Among the numerous methods validated in clinical practice, the authors have chosen the I-PASS method (Illness, Patient, Action, Situation, Synthesis) for its effectiveness on a clinical level, to prevent AEs, and because it is easily tailored to the various work environments in which Italian Anaesthesiologists and Intensivists operate.
... Effective communication can not only positively influence patient safety and satisfaction but also reduce frustration among healthcare staff. 16 We did not measure the effect of provider burnout in this study; however, others have documented that poor communication leads to additional workload or duplication of effort, which most likely exacerbates provider burnout. Of all the interventions to address provider burnout, improving effective communication between providers may be a relatively high-impact, low-resource method to reduce burnout. ...
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Introduction: Handoffs and transitions of care are common weak points in healthcare provider communication as patients move between sites. With no consistent pattern of communication between St. Jude Children's Research Hospital (St. Jude) and its affiliated clinics, the Affiliate Program Office at St. Jude developed and implemented a standardized communication tool to facilitate patient transitions between different healthcare sites. Methods: Each team of providers created flow diagrams to define the current state of communication when patients were transitioning between remote sites. Fishbone diagrams identified the common barriers to effective communication as a lack of consistent communication and ownership. We developed a communication tool to address these barriers, which was disseminated by secure email. We measured the percent usage of the completed hand-off tool before a patient transitioned, staff experience, and the number of errors. Results: The time to send or receive the communication bundle was <10 minutes. Within 3 months of implementing the SMART bundle at 3 pilot sites, the bundle was used completely in 6 of 8 patient transitions and was associated with somewhat improved staff satisfaction. We identified no adverse events related to the communication bundle. Conclusions: In this small pilot study, we accomplished closed-loop communication between geographically remote healthcare sites by using an electronically transmitted standardized communication bundle.
... Cost of communication inefficiencies has also been explored in [30]. The authors point out that outages in communication services are a common cause of wasted time for physicians and nurses, increasing the stay for inpatients. ...
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The unavailability of information and communication services due to network-related incidents may have a significant impact on large organizations. Network incidents can hence be viewed as a risk for organizations whose consequences are not accounted for by traditional network design problems. In this work, we address the problem of designing a reliable wired network from a risk analysis perspective. We propose a novel methodology for the quantitative assessment of the risk associated with network-related incidents in a hospital campus. We then define an optimization problem to find the topology that minimizes the network cost plus the expected loss over time attributable to the unavailability of corporate services to staff affected by network incidents. A case study illustrates our methodology and its benefits. Using available public information, we design the topology of a campus network for a large hospital where the cost of labor exceeds 200 M€/year. The solution to our optimization problem is found through well-known genetic algorithms and provides a topology where network nodes with a higher impact on productivity exhibit higher reliability. As a consequence, the topology obtained reduces more than 95% (+392 000€) the expected annual lost profits when compared to common reduced-cost topologies such as the minimum-cost ring or the non-reliable minimum-cost tree, showing that investment in risk reduction pays off. Our contribution may be used by engineers to (re)design cost-effective reliable networks or by hospital managers to support decisions on updating present infrastructure based on risk reduction.
... In contrast, delayed, inaccurate or incomplete information transfer may result in additional workload for health care providers (6), treatment delays (6), loss of patient confidence (7), greater (and avoidable) costs to the health care system (7) and impaired patient safety (8). Consequently, high-quality communication has been described as a fundamental and critical factor for 'the practice and delivery of healthcare' (9). ...
Article
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Background: Timely and accurate communication between primary and secondary care is essential for delivering high-quality patient care. Objective: The aim of this study is to evaluate the content contained in both referral and response letters between primary and secondary care and measure this against the recommended national guidelines. Methods: Using an observational design, senior medical students and their general practice supervisors applied practice management software to identify 100 randomly selected adults, aged greater than 50 years, from a generated list of consults over a 2-year period (2013-2015). All data included in referral and response letters for these adults were examined and compared with the gold standard templates that were informed by international guidelines. Results: Data from 3293 referral letters and 2468 response letters from 68 general practices and 17 hospitals were analysed. The median time that had elapsed between a patient being referred and receiving a response letter was 4 weeks, ranging from 1 week for Emergency Department referral letters to 7 weeks for orthopaedic surgery referral letters. Referral letters included the reason for referral (98%), history of complaint (90%) and current medications (82%). Less commonly included were management prior to referral (65%) and medication allergies (57%). The majority of response letters included information on investigations (73%), results (70%) and follow-up plan (85%). Less commonly, response letters included medication changes (30%), medication lists (33%) and secondary diagnoses (13%). Conclusions: Future research should be aimed at developing robust strategies to addressing communication gaps reported in this study.
... The practice and delivery of health care is fundamentally and critically dependent on effective and efficient communication. 8 Across health settings, poor communication-both among staff and with patients-has been linked to medical errors, poorer patient outcomes, lower patient satisfaction, longer stays, and higher costs. 9 A well-established body of research indicates that health literacy may be the "missing link" to understanding and addressing disparities, 10 and the NASEM report identifies health literacy as a key factor underlying SDOH. ...
Article
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The seminal Consensus Study by the National Academies of Science, Engineering, and Medicine released in September 2019 describes the benefits of integrating health and social care service delivery, underscoring the central role of social determinants of health (SDOH) in health outcomes. Although the report’s focus on the integration of health and social care contributes a much needed perspective to the national discourse on SDOH and offers a useful framework for organizing service delivery activities, the omission of prevention and health promotion throughout the report is a substantial limitation. We call for increased attention to and investment in prevention and health promotion in the proposed 5As framework. We contend that effectively addressing SDOH and improving alignment between health and social systems require reconceptualization of the traditional health care workforce and renewed state and national advocacy efforts. A paradigm shift encompassing a broader “workforce for health” that is well trained in prevention, health promotion, and advocacy is critical to addressing SDOH, improving population health outcomes, and achieving health equity. Given their professional mission, training, expertise, and scope of practice, social workers are well positioned to lead this effort.
... The delivery and practice of high-quality healthcare are strongly dependent on effective communication [14,15]. At the beginning of the DUETS, the initial three cases of thrombosis led us to revise our protocol. ...
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Uterus transplantation is a treatment solution for women suffering from absolute uterine factor infertility. As much as 19.5% of uterus-transplanted patients underwent urgent graft hysterectomy due to thrombosis/hypoperfusion. The necessity to identify candidates with high-quality uterine vasculature is paramount. We retrospectively evaluated and compared the imaging results with actual vascular findings from the back table. In this article, we present a novel radiologic grading scale (DUETS classification) for evaluating both uterine arteries and veins concerning their suitability for uterus procurement and transplantation. This classification defines several criteria for arteries (caliber, tapering, atherosclerosis, tortuosity, segment, take-off, and course) and veins (caliber, tapering, plethora, fenestrations, duplication/multiplicity, dominant route of venous drainage, radiologist’s confidence with imaging and assessment). In conclusion, magnetic resonance angiography can provide reliable information on uterine venous characteristics if performed consistently according to a well-established protocol and assessed by a dedicated radiologist. The caliber of uterine arteries seems to be inversely related to the time passed since the last delivery. We recommend that the radiologist comments on the reliability and confidence of the imaging study. It cannot be over-emphasized that the most crucial aspect of surgical imaging is the necessity of high-quality communication between a surgeon and a radiologist.
... Additionally, in developing communication, Emotional Intelligence (EI from now on) (9) and empathy (10) play a fundamental role. In this sense, there are studies on the relations of the attitudes towards communication, EI, and empathy (11)(12) . These variables can be influenced by intrinsic and extrinsic factors, like the type of service where the nurses work (general hospitalization or special services) and the type of contract (permanent or temporary) (13)(14) . ...
Article
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Objective: to evaluate the relation and the moderating effect of the organizational factors on the attitudes towards communication, empathy, and emotional intelligence in the nurses. Method: a cross-sectional study was conducted with a convenience sample of 268 nurses from Valencia, Spain. The attitudes towards communication were evaluated by means of the specifically designed instrument, those towards empathy with the Jefferson’s Scale of Empathy for Nursing Students, and those towards emotional intelligence by means of the Trait Meta-Mood Scale, consisting of 24 items. The effect of the studied variables was assessed by means of ANOVA, multiple linear regression models were applied, and the moderating effect was analyzed using PROCESS. Results: there are statistically significant differences based on the type on contract (permanent); and statistically significant differences were found in the cognitive dimension of the attitudes towards communication. Regarding the regression models, the perspective taking dimension of empathy was the main predictive variable tn the dimensions of the attitudes towards communication. Finally, a moderating effect of the type of contract was evidenced in the effect of emotional reparation over the cognitive dimension of the attitudes towards communication. Conclusion: the organizational factors exert an influence on the attitudes towards communication, empathy, and emotional intelligence.
... outcomes [10], better adherence to treatment [11], and general patient satisfaction [12]. Conversely, negative outcomes (e.g., increased hospital stay) and higher costs have been associated with deficient communication [13]. It therefore appears important to devote more resources and time to the acquisition by future nursing professionals of communication skills using effective methodologies [6,14]. ...
Article
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Communication is one of the determining factors of healthcare quality; however, a health model that prioritizes clinical over non-technical skills remains prevalent. The aims of this article were: (a) to validate a communication skills scale in a sample of fourth-year nursing degree students from two Spanish universities and (b) determine their perception of communication skills. The study included 289 fourth-year nursing undergraduate students with a mean age of 22.7 (SD = 4.87) years; 81.7% were female. The Health Professionals Communication Skills Scale (HP-CSS) questionnaire was adapted for use among nursing students. We analysed the psychometric properties and relationships with the variable attitudes toward communication skills. The HP-CSS showed a high internal consistency (0.88) and good fit of data to the model (TLI = 0.98; CFI = 0.97; RMSEA = 0.05 [95% CI = 0.04-0.06]). The total score and subscale scores correlated with the variable attitude towards communication skills. High scores were obtained for the students' perception of communication skills. The HP-CSS is a valid and reliable tool to assess the communication skills in nursing students. This scale provides university teachers with a rapid and easily applied instrument to assess the level of communication skills and relationship with patients.
... The average stay rate enables checking for efficiency in all processes involving the patient. It is related to increased costs (Titler et al., 2008); quality of process management (Andritsos & Tang, 2014); errors caused during the bed hygiene or while care professionals provide services (Agarwal, Sands, & Schneider, 2010); and generation of income due to flow improvement (New, McDougall, & Scroggie, 2016 Planning the patient's discharge is another process which can be investigated as an indicator of efficiency. Given the fragmentation of the assistance given and the possibility of iatrogenic diseases that a longer stay may cause to the patient, the discharge planning results from the integration between the various professionals who collaboratively interact to provide a patient-centered assistance (Rhodes, 2013). ...
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Despite all quality management and integration literature prescriptions to implement strategies for a better organizational performance, healthcare organizations support a model that is inefficient, expensive, and unsustainable over time. This work aims to examine the interpersonal relationships in three large hospitals located in Southern Brazil and its relation with organizational efficiency. Through a qualitative and explanatory research, semi-structured interviews were applied to 32 professionals, in addition to a document analysis. The data analysis shows that integration occurs at the formal leadership level only in one of the organizations and does not involve the medical and operational professionals. Quality management seems not to be fully incorporated into care routines, and are related to efficiency losses. This scenario is probably related to the lack of integration among the professionals and the consolidation of trust, leadership, and communication.
... In the healthcare setting, while there is appreciation for effective teamwork and collaboration in general, specific research examining face-to-face communication is scant. Collaboration and communication in healthcare are associated with employee satisfaction [9], medical costs [10] and quality of patient care [11]. One self-report study found that multidisciplinary medical teams that used face-to- ...
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Wearable sensor technology enables objective data collection of direct human interactions. The authors review sociometric wearable devices (SWD) and their application in healthcare. Human interactions captured by wearable sensors have been shown to correlate with social constructs such as teamwork and productivity in the office. Application of SWD in the field of healthcare requires special considerations: validation studies have shown technological disadvantages in acute medical settings. Application of SWD in healthcare should be considered based on the strengths and weaknesses of the methodology. SWD can also play an important role in investigation of human interaction and epidemic spread. When study designs and methodologies are carefully considered, incorporation of SWD in healthcare research has promising potential for new insights.
... An estimated 80% of serious medical errors involve miscommunication during patient transfers [5]. Furthermore, inefficiencies in communication contribute to an estimated annual loss of $12 billion in the United States alone [6]. ...
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Introduction Miscommunication during patient handoff contributes to an estimated 80% of serious medical errors and, consequently, plays a key role in the estimated five million excess deaths annually from poor quality of care in low- and middle-income countries (LMICs). Objective The objective of this study was to assess signout communication during patient handoffs between prehospital personnel and hospital staff. Methods This is a cross-sectional study, with a convenience sample of 931 interfacility transfers for pregnant women across four states from November 7 to December 13, 2016. A complete signout, as defined for this study, contains all necessary signout elements for patient care exchanged verbally or in written form between an emergency medical technician (EMT) and a physician or nurse. Results Enrollment of 786 cases from 931 interfacility transfers resulted in 1572 opportunities for signout. EMTs and a physician or nurse signed out in 1549 cases (98.5%). Signout contained all elements in 135 cases (8.6%). The mean percentage of signout elements included was 45.2% (95% CI, 43.9-46.6). Physician involvement was correlated with a higher mean percent (63.4% [95% CI, 62-64.8]) compared to nurse involvement (23.6% [95% CI, 22.5-24.8]). With respect to the frequency of signout communication, 63.1% of EMTs reported often or always giving signout, and 60.5% reported often or always giving signout; they reported feeling moderately to very comfortable with signout (73.7%) and 34.1% requested further training. Conclusions Physicians, nurses, and the EMTs conducted signout 99% of the time but often fell short of including all elements required for optimal patient care. Interventions aimed at improving the quality of patient care must include strengthening signout communication.
... Well-developed visual observation skills specifically are important to healthcare providers in assessing patient needs and providing safe patient care (Hall, Brajtman, Weaver, Grassau, & Varpio, 2014a). The Joint Commission notes that miscommunication is responsible for 80% of serious medical errors (The Joint Commission, 2012), with estimates that up to 440,000 deaths per year are due to preventable medical errors (James, 2013), and amount to accumulated losses of $12 billion annually in the U.S. (Agarwal, Sands, & Schneider, 2010). To improve communication, interprofessional education (IPE) tenets reinforce shared accountability, shared problem-solving, and shared decision-making (Interprofessional Education Collaborative Expert Panel, 2011). ...
Article
Aim: In this interprofessional education Art Applications Workshop, 104 medicine, nursing and psychology students apply skills developed through visual arts observations that enhance students' collaboration, communication, and observational skills to standardized patient encounters. Students observe two-dimensional images, write case reports on the paintings' subjects, and apply principles to complete assessment notes on standardized patients. This descriptive paper's goal is to disseminate this interprofessional curriculum and share experiences in implementing this workshop. Background: Visual arts education in healthcare programs expand students' visual, tactile and oral expression, especially in collaborative team settings. Methods: In session 1, student teams analyze paintings and learn visual assessment techniques. In session 2, student teams observe paintings in a museum setting and write observations in case notes. In session 3, student teams apply visual assessment techniques to standardized patient interviews, write patient histories, assessment notes, and finally, complete post-survey self-evaluations. Results: In the standardized patient assessment 73% of students made accurate diagnosis with supporting evidence in patient histories and notes. In post-survey results, 91% of students agreed/strongly agreed they improved their visual observation skills, 92% agreed/strongly agreed they improved their communication skills in listening and encouraging the ideas and opinions of other team members, 91% agreed/strongly agreed they are more confident in communicating with students from different disciplines, and 97% agreed/strongly agreed they are more confident in collaborating with students from different disciplines. Conclusions: This Workshop demonstrates enhanced self-reported perceptions of collaboration, observation, and communication skills in case notes and standardized patient assessment notes.
... This tool was used in a previous study (1). Sharing the patient's information with other care providers (physicians, nurses, specialists, and other hospital staff) requires concise and effective communication (2). As the disease becomes more complex, the need for having more effective communication rises. ...
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Introduction: Highly professional communication could result in the improvement of the quality of care such as reduced mortality, medical error, length of stay, and unplanned readmission. Therefore, the purpose of this study was to determine the nurses' perception of nurse-physician professional relationship in Abu-Ali-Sina organ transplant hospital of Shiraz. Methods: This is a descriptive study performed cross-sectionally in Abu-Ali-Sina hospital in Shiraz in 2020. The sampling method was the census. All nurses working at Abu-Ali-Sina Organ Transplant Hospital (N=295) participated in the study, so no sampling was applied. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 24. Results: The finding of this study showed that the level of professional nurses-physician relationship was moderate from the nurses' point of view. Reporting of patient issues to physicians (72.2%), physicians' respect (67.8%), and trust (66.1%) to nurses were highly desirable at Abu-Ali-Sina Hospital. However, the nurse's assertive skills to tell the physicians' errors (14.2%) and their encouragement by physicians (10.2%) were not favorable. Conclusion: From the results, it is possible to conclude that the nurse-physician professional relationship is at a moderate level in Abu-Ali Sina Transplant Center. Further studies are need to implement intervention for improving the level of physician and nurse's relationship.
... The average stay rate enables checking for efficiency in all processes involving the patient. It is related to increased costs (Titler et al., 2008); quality of process management (Andritsos & Tang, 2014); errors caused during the bed hygiene or while care professionals provide services (Agarwal, Sands, & Schneider, 2010); and generation of income due to flow improvement (New, McDougall, & Scroggie, 2016 Planning the patient's discharge is another process which can be investigated as an indicator of efficiency. Given the fragmentation of the assistance given and the possibility of iatrogenic diseases that a longer stay may cause to the patient, the discharge planning results from the integration between the various professionals who collaboratively interact to provide a patient-centered assistance (Rhodes, 2013). ...
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Despite all quality management and integration literature prescriptions to implement strategies for a better organizational performance, healthcare organizations support a model that is inefficient, expensive, and unsustainable over time. This work aims to examine the interpersonal relationships in three large hospitals located in Southern Brazil and its relation with organizational efficiency. Through a qualitative and explanatory research, semi-structured interviews were applied to 32 professionals, in addition to a document analysis. The data analysis shows that integration occurs at the formal leadership level only in one of the organizations and does not involve the medical and operational professionals. Quality management seems not to be fully incorporated into care routines, and are related to efficiency losses. This scenario is probably related to the lack of integration among the professionals and the consolidation of trust, leadership, and communication.
... 10 In theory, a team-based approach to clinical messaging allows individuals to respond to their respective messages while ensuring that the rest of the team remains informed about the patient's care. 7,14 However, in practice, many of these messages lead to unnecessary interruptions from an individual's current scope of patient care. 15 A growing research literature has suggested that care team members receive an increasingly high volume of asynchronous clinical communications, which lead to professional exhaustion and burnout. ...
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Objective A growing research literature has highlighted the work of managing and triaging clinical messages as a major contributor to professional exhaustion and burnout. The goal of this study was to discover and quantify the distribution of message content sent among care team members treating patients with breast cancer. Materials and Methods We analyzed nearly two years of communication data from the electronic health record (EHR) between care team members at Vanderbilt University Medical Center. We applied natural language processing to perform sentence-level annotation into one of five information types: clinical, medical logistics, nonmedical logistics, social, and other. We combined sentence-level annotations for each respective message. We evaluated message content by team member role and clinic activity. Results Our dataset included 81 857 messages containing 613 877 sentences. Across all roles, 63.4% and 21.8% of messages contained logistical information and clinical information, respectively. Individuals in administrative or clinical staff roles sent 81% of all messages containing logistical information. There were 33.2% of messages sent by physicians containing clinical information—the most of any role. Discussion and Conclusion Our results demonstrate that EHR-based asynchronous communication is integral to coordinate care for patients with breast cancer. By understanding the content of messages sent by care team members, we can devise informatics initiatives to improve physicians’ clerical burden and reduce unnecessary interruptions.
... The average stay rate enables checking for efficiency in all processes involving the patient. It is related to increased costs (Titler et al., 2008); quality of process management (Andritsos & Tang, 2014); errors caused during the bed hygiene or while care professionals provide services (Agarwal, Sands, & Schneider, 2010); and generation of income due to flow improvement (New, McDougall, & Scroggie, 2016 Planning the patient's discharge is another process which can be investigated as an indicator of efficiency. Given the fragmentation of the assistance given and the possibility of iatrogenic diseases that a longer stay may cause to the patient, the discharge planning results from the integration between the various professionals who collaboratively interact to provide a patient-centered assistance (Rhodes, 2013). ...
Article
Full-text available
Despite all quality management and integration literature prescriptions to implement strategies for a better organizational performance, healthcare organizations support a model that is inefficient, expensive, and unsustainable over time. This work aims to examine the interpersonal relationships in three large hospitals located in Southern Brazil and its relation with organizational efficiency. Through a qualitative and explanatory research, semi-structured interviews were applied to 32 professionals, in addition to a document analysis. The data analysis shows that integration occurs at the formal leadership level only in one of the organizations and does not involve the medical and operational professionals. Quality management seems not to be fully incorporated into care routines, and are related to efficiency losses. This scenario is probably related to the lack of integration among the professionals and the consolidation of trust, leadership, and communication.
... The average stay rate enables checking for efficiency in all processes involving the patient. It is related to increased costs (Titler et al., 2008); quality of process management (Andritsos & Tang, 2014); errors caused during the bed hygiene or while care professionals provide services (Agarwal, Sands, & Schneider, 2010); and generation of income due to flow improvement (New, McDougall, & Scroggie, 2016 Planning the patient's discharge is another process which can be investigated as an indicator of efficiency. Given the fragmentation of the assistance given and the possibility of iatrogenic diseases that a longer stay may cause to the patient, the discharge planning results from the integration between the various professionals who collaboratively interact to provide a patient-centered assistance (Rhodes, 2013). ...
Article
Full-text available
Despite all quality management and integration literature prescriptions to implement strategies for a better organizational performance, healthcare organizations support a model that is inefficient, expensive, and unsustainable over time. This work aims to examine the interpersonal relationships in three large hospitals located in Southern Brazil and its relation with organizational efficiency. Through a qualitative and explanatory research, semi-structured interviews were applied to 32 professionals, in addition to a document analysis. The data analysis shows that integration occurs at the formal leadership level only in one of the organizations and does not involve the medical and operational professionals. Quality management seems not to be fully incorporated into care routines, and are related to efficiency losses. This scenario is probably related to the lack of integration among the professionals and the consolidation of trust, leadership, and communication.
... Indeed, communication problems can constitute a substantial financial burden for hospitals. For example, Agarwal et al. [1] use a combination of qualitative executive level interviews at seven hospitals and existing time and motion studies to estimate the financial impact of inefficiencies in communication between staff members. They estimate that at least $2.2 million on average are lost per hospital in the U.S. due to poor communication. ...
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This study analyzes the effect of economies of scale and scope on the optimal case mix of a hospital or hospital system. With respect to the ideal volume and patient composition, the goal is to evaluate (i) the impact of changes in the efficiency of resource use with increasing scale, and (ii) to determine the potential effects of spreading fixed costs over a greater number of patients. The problem is formulated as a non-linear mixed integer program. It turns out that this non-linear program is too difficult to be solved with standard software. As an alternative, an iterative procedure using piecewise linear approximations to derive lower and upper bounds is proposed and shown to converge to the optimum. The procedure is applied using a public database on German hospital costs and performance statistics. Results indicate that changes in the efficiency of resource use with increasing scale have a considerable impact if similar services can be consolidated, e.g., among different departments. However, if the scope for decision-making regarding the case mix of a hospital is limited, such changes may be negligible.
... 14-16 These failings not only harm patients, but also lead to significant financial costs for healthcare providers. 17 Outside of healthcare, there has been a technological revolution in handheld communication devices spawning new ways to effectively and reliably communicate, collaborate, and share information. The requirements for immediacy and accuracy of communication within healthcare, together with the potentially harmful consequences of communication failure, mean that emergent communication technologies must be studied robustly. ...
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Objectives: Effective communication is critical to the safe delivery of care but is characterized by outdated technologies. Mobile technology has the potential to transform communication and teamwork but the evidence is currently uncertain. The objective of this systematic review was to summarize the quality and breadth of evidence for the impact of mobile technologies on communication and teamwork in hospitals. Materials and methods: Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL Plus, HMIC, Cochrane Library, and National Institute of Health Research Health Technology Assessment) were searched for English language publications reporting communication- or teamwork-related outcomes from mobile technologies in the hospital setting between 2007 and 2017. Results: We identified 38 publications originating from 30 studies. Only 11% were of high quality and none met best practice guidelines for mobile-technology-based trials. The studies reported a heterogenous range of quantitative, qualitative, and mixed-methods outcomes. There is a lack of high-quality evidence, but nonetheless mobile technology can lead to improvements in workflow, strengthen the quality and efficiency of communication, and enhance accessibility and interteam relationships. Discussion: This review describes the potential benefits that mobile technology can deliver and that mobile technology is ubiquitous among healthcare professionals. Crucially, it highlights the paucity of high-quality evidence for its effectiveness and identifies common barriers to widespread uptake. Limitations include the limited number of participants and a wide variability in methods and reported outcomes. Conclusion: Evidence suggests that mobile technology has the potential to significantly improve communication and teamwork in hospital provided key organizational, technological, and security challenges are tackled and better evidence delivered.
... On the other hand, study found that 78.1% of hospital nurses regularly use their mobile phones for non-work-related activities at work [9]. The negative implications of such a practice are the potential distraction of these mobile devices [8], patients' information confidentiality as the effective communication between healthcare professionals is centered for patient safety and quality of care [9,10]. Furthermore, there were barriers and difficulties in nursephysician after-hours phone communication where nurses working under stress situation with scarce resources and fatigue whereas physician could be distracted in an inappropriate environment but ought to make prompt diagnosis and clinical decision over the phone [1]. ...
... Mit Secure Instant Messaging (SIM) steht Leistungserbringer*innen und Gesundheitsämtern ein verschlüsselter und asynchroner Kommunikationsweg zur Verfügung, mit dem etablierte Möglichkeiten synchroner Kommunikation, insbesondere das Telefon, ergänzt und entlastet werden können [8,9]. Darüber hinaus ist SIM schneller, weniger formell und flexibler in der Anwendung als die E-Mail-Kommunikation und kann dabei helfen, Kommunikationsprozesse zu beschleunigen [10,11]. ...
Article
Zusammenfassung Hintergrund Insbesondere zu Beginn der COVID-19-Pandemie klagten hausärztliche Praxen über eine für sie unsichere Informationslage und in diesem Zusammenhang über einen unzureichenden Informationsfluss von den zuständigen Gesundheitsämtern. Secure Instant Messaging beschreibt eine digitale, chatbasierte Kommunikationsstruktur, die es Akteur*innen im Bereich der ambulanten Primärversorgung ermöglichen könnte, sich in Echtzeit zu vernetzen und niedrigschwellig über Sektorengrenzen hinweg Informationen auszutauschen. Das als Proof-of-Concept-Studie angelegte Projekt KomPan hat in zwei deutschen Modellregionen eine solche sichere Echtzeitkommunikationsstruktur implementiert, um in der Pandemiesituation einen zusätzlichen Kommunikationsweg zwischen Sektoren des Gesundheitssystems zu schaffen und insbesondere den Austausch zwischen Hausärzt*innen und den Gesundheitsämtern zu vereinfachen. An dieser Stelle werden die Ergebnisse der qualitativen Nutzer*innenbefragung vorgestellt. Methode Beginnend mit Dezember 2020 (2. COVID-19-Welle) wurde Hausärzt*innen (n = 43) und Gesundheitsamtsmitarbeitenden (n = 10) in zwei hessischen Modellregionen die Secure Instant Messaging-App „Famedly“ der Famedly GmbH zur Verfügung gestellt. Nach einer mehrmonatigen Nutzungszeit befragten wir Projektteilnehmer*innen in leitfadengestützten Telefoninterviews zu ihren Nutzungserfahrungen mit dem Messenger. Die leitgebende Fragestellung war dabei: Wie hat sich die Kommunikation zwischen den beteiligten Akteur*innen durch Secure Instant Messaging geändert? Die Interviews wurden wörtlich transkribiert und mittels thematischer Analyse ausgewertet. Ergebnisse Es wurden Interviews mit 10 Hausärzt*innen und 2 Mitarbeiter*innen aus den Gesundheitsämtern geführt. Die Nutzung einer auf Secure Instant Messaging basierenden Kommunikationsplattformbeförderte die interkollegiale Vernetzung zwischen Hausärzt*innen während der Pandemie. Auf die Kommunikation zwischen Gesundheitsämtern und Hausärzt*innen hatte die App demgegenüber nur wenig Einfluss. Die zum Teil entgegengesetzten Erwartungen und Nutzungsweisen der beiden Nutzungsgruppen (Hausärzt*innen und Gesundheitsamtsmitarbeiter*innen) führten (neben anderen Gründen) letztlich dazu, dass die Möglichkeit zur direkten transsektoralen Kommunikation mittels Secure Instant Messaging im Untersuchungsverlauf weitestgehend ungenutzt blieb. Schlussfolgerung Insbesondere in der Pandemiesituation stellt die Etablierung von Secure-Instant-Messaging-Gruppen mit regionalem Bezug für Hausärzt*innen eine willkommene Kommunikationsmöglichkeit dar, die dazu beitragen kann, interkollegiale Vernetzung zu befördern und dadurch die fluktuierende Pandemiesituation besser zu bewältigen. Es gibt Hinweise darauf, dass die effektive Anwendung von Secure Instant Messaging für die transsektorale Kommunikation demgegenüber erst im Rahmen umfassender Digitalisierungsbemühungen institutioneller Kommunikationsstrukturen mit dem Ziel einer stärkeren Vernetzung lokaler Versorgungsakteur*innen gelingt.
... This has an impact on the patient's satisfaction (Mcgilton et al., 2012;Haugan, 2014;Hemsley et al., 2011;Lasiter, 2014). It also increases the length of hospital staythat accounts for 53% of hospitals' total waste (Agarwal et al., 2010). ...
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Background: Therapeutic communication is a purposeful interaction between health professionals and patients that helps to achieve positive health outcomes. There is a pressing need for research examining factors influencing effective implementation of therapeutic communication in relation to patient-centered care and satisfaction. Objective: This study was aimed at determining the effective implementation of therapeutic communication and its predictors. Methods: Institution based cross-sectional study was conducted at the Jimma University Specialized Hospital from March 21 to April 9, 2016. One hundred ninety two patients were recruited using stratified sampling. A questionnaire was used to collect data. One-way ANOVA for mean difference by socio-demographic characteristics, simple and multivariable linear regressions were conducted. Results: The study revealed that 67(34.9%) of the patients rated high level of therapeutic communication. Significant predictors of therapeutic communication implementation were educational status (β = 5.87, P = 0.011), language difference (β = -6, P = 0.014), education difference (β = 5.21, P = 0.010) and perceived patient view score (β = 3.57, P˂0.001). Conclusion: Therapeutic communication was poorly implemented. Education, language difference, education difference and perceived patient view scores were significant predictors of therapeutic communication.
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Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.
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There are no studies describing the nature and quality of telephone consultations for critically ill children despite being an important part of pediatric intensive care. We described pediatric telephone consultations to a PICU in Ontario, Canada in 2011 and 2012. Of 203 consultations, 104 patients (51.2%) were admitted to the PICU; this was associated with weekend consultations (p = 0.005) and referral hospital location (p = 0.036). Frequency of interruptions was 1 in every 3.2 (2.0, 5.7) minutes and not associated with call content. Twenty-one percent of consults had limited discussion of vital signs. Our study described our center's remote critical care consultation program and outcomes.
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Objectives Efficient and accurate communication between healthcare professionals (HCPs) serves as the backbone to safe and efficient care delivery. Traditional pager-based interpersonal communication may contribute to inefficient communication practices and lapses in medical care. Methods This study aimed to examine the impact of Medic Bleep, a National Health Service (NHS) information governance-compliant instant messaging application, in an NHS Hospital Trust. We examined Medic Bleep’s impact on participant time and workflow using time–motion methodology. Cohorts of doctors and nurses using both Medic Bleep and the traditional pager were compared. Secondary endpoints of our study were to assess whether efficient communications could lead to better resource utilisation, patient safety as well as better quality of work life for the end user. Results Assimilation of Medic Bleep corresponded to a reduction in mean task-duration that was statistically significant (p < 0.05) for To Take Out (TTO) and Patient Review categories. Nurses saved an average of 21 minutes per shift (p < 0.05), whereas doctors saved an average of 48 minutes (p < 0.05) per shift. Qualitative analysis suggested that HCPs benefited from better work prioritisation, collaboration and reduced medical errors enabled by an auditable communication workflow. Conclusion Medic Bleep reduced time spent on the tasks requiring interpersonal communication. Efficiencies were seen in Discharge Patient Flow, Patient Review and TTO categories. This improved HCP availability and response times to the benefit of patients. End users revealed that Medic Bleep had a positive effect on quality of work life.
Article
Clinical communication platforms have become such disparate systems that some health care organizations experience confusion, wasted time, and clinician dissatisfaction, resulting in quality and safety issues for nurse leaders. Yet, health care communication technologies are evolving rapidly. This article evaluates the evidence around improving inpatient clinical communication through an in-depth literature search and industry review of best practices; providing essential information about the benefits of unifying clinical communication across interprofessional teams. For an ongoing Kaiser Permanente nursing performance improvement project, 130 articles, industry papers and expert opinions were reviewed, and recommendations are presented for nurse leaders seeking to improve clinical communication and collaboration and to meet the Quadruple Aim in their organizations.
Article
Objective Effective communication is fundamental to helping patients change behaviour. Few studies have operationalised how to quantify and improve the patient centeredness of communication during the dietitian outpatient consultation. We sought to evaluate the impact of a renal diet question prompt sheet (QPS) on patient centeredness (PC) in dietitian outpatient clinics and describe the impact of a renal diet QPS on the volume and pattern of communication between dietitians (n = 4) and patients/carers (n = 24, n = 11). Methods The Roter Interaction Analysis System was used to compute a PC index, the volume communication (number of questions and utterances) and categorise dietitian communication. Results The QPS was associated with significant improvements in the PC of communication (p = 0.004 and p = 0.001), without increasing the volume of communication. The QPS was also associated with an increase in the total number of questions asked (p < 0.0001) especially from patients (p = 0.0009); and an increase in the volume of communication devoted to education and counselling (p < 0.0001). Conclusions This study describes a promising intervention to increase the patient centeredness of dietetic consultations in an outpatient setting. Practice implications Whilst simple in design, the use of a QPS had a large effect on how patients and carers interact with the dietitian in the outpatient setting.
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Objective Discharge Summary (DS) is the vital document for the ongoing patient care. We aimed to improve the quality of DS given from our pediatric ward of tertiary teaching hospital. Methods We introduced longitudinal multimodal program. Residents preparing the DS were given the education in a small group. Peer audit of the summaries were done by each residents at several occasions followed by feedback from consultant concluding the lesions for improvement. Summaries rechecking by senior residents or consultants was made mandatory once prepared by junior residents. Discussion on discharge processes was emphasized during the ward round including DS documentation points. We didn’t find suitable pediatric DS assessment tool in the literature. We developed a scoring system evaluating 33 components of DS under seven broad headings. A scoring tool had good inter-rater reliability. We introduced the program in May 2018. 33 summaries were evaluated each from last quarter (October to December) of the calendar year 2017, 2018, and 2019 as a pre-intervention, post-intervention, and retention analysis respectively. Results Analysis of Variance (ANOVA) revealed that the Mean(SD) total % score improved significantly (P<0.001). However, the post-hoc test showed that the improvement was significant (p=0.01) from 2017 to 2018 but from 2018 to 2019 improvement was statistically non-significant (p=0.43). Domains like History, Physical Examination, and Discharge Plan were improved significantly, but the domain of Hospital Course was resistant to improve despite interventions. Conclusion DS quality prepared by the residents in a teaching institute can be improved by various educations approaches and work system changes.
Article
Introduction The multi-disciplinary care offered to patients with multi-morbidities offers a powerful example of the practical challenges faced by the National Health Service's planned move to more closely integrated models of care. Purpose, objective, and contributions The intention of this work was to identify the opportunities and obstacles presented by the current provision of integrated care and explore their implications for existing and future policy initiatives. Materials and Methods We conducted a qualitative exploration of the experiences of senior managers, commissioners and clinicians, using a post-hoc content analysis to populate and present the results within the multi-componential Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework designed to understand integrated care. Results A total of 13 senior medical directors, commissioners, and managers, and 15 clinicians from a range of care settings were interviewed. Relative factors within the six framework components were identified namely; issues around communication between settings (Service delivery), the importance of collaborative leadership (Leadership & governance); the need for high-level collaboration (Workforce), better directed financial incentives (Financing), the lack of software interoperability (Technologies and medical products) and constraints on sharing and utilising patient data (Information & Research). Conclusions The SELFIE framework has provided valuable insight into the challenges presented by inter-organisational and inter-professional working that will help guide the design and implementation of policies promoting integrated care. These may be mitigated by sharing the varied experiences and priorities that exist across primary and care settings, alongside improving communication and supporting collaborative leadership. There also appears a clear role for refocussing financial incentives to reward shared responsibility at all levels of service delivery.
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Objective The relevance of communication in medical education is continuously increasing. At the Medical Faculty of Hamburg, the communication curriculum was further developed and optimized during this project. This article aims to describe the stakeholders’ perceived challenges and supporting factors in the implementation and optimization processes. Methods The initial communication curriculum and its development after a one-year optimization process were assessed with a curricular mapping. A SWOT analysis and group discussions were carried out to provide information on the need for optimization and on challenges the different stakeholders faced. Results The curricular mapping showed that the communication curriculum is comprehensive, coherent, integrated and longitudinal. In both the implementation and the project-related optimization processes, support from the dean, cooperation among all stakeholders and structural prerequisites were deemed the most critical factors for successfully integrating communication content into the curriculum. Conclusion The initiative and support of all stakeholders, including the dean, teachers and students, were crucial for the project’s success. Practice implications Although the implementation of a communication curriculum is recommended for all medical faculties, their actual implementation processes may differ. In a “top-down” and “bottom-up” approach, all stakeholders should be continuously involved in the process to ensure successful integration.
Article
Objectives: Medication information is frequently communicated via free-text computerized provider order entry (CPOE) orders in electronic health records. When such information is transmitted separately from a structured CPOE medication order, there is a significant risk of medication error. Although prior studies have described the frequency of using free-text CPOE orders for communicating medication information, there is a gap in understanding the nature of the medication information contained in the free-text CPOE orders. The aims of this study are to (1) identify the most common medication names communicated in free-text CPOE orders and their risk levels and (2) identify what actions physicians expect that nurses will complete when they place free-text CPOE orders, and (3) describe differences in these patterns across hospitals. Methods: This study was a retrospective analysis of a sample of 26,524 free-text CPOE orders from 6 hospitals in the mid-Atlantic U.S. region. Results: Free-text CPOE orders contained in the sample mentioned 193 medication names. Free-text CPOE orders were used frequently to communicate information about naloxone, heparin, flumazenil, and dextrose. Twenty-two percent of the free-text CPOE orders related to discontinuing medication(s), whereas 7% of the free-text CPOE orders relate to giving medication(s). There was high variation across hospitals both in the percentage of free-text CPOE orders mentioning medication information and in the proportion of those that referred to high-risk medications. Conclusions: The prevalence of medication information in free-text CPOE orders may suggest specific communication challenges in respect to urgency, uncertainty, planning, and other aspects of communication and clinical needs. Understanding and addressing communication challenges around commonly mentioned medication names and actions, especially those that are high risk, can help reduce the risk of medication errors.
Article
Purpose The use of patient-specific implants for reconstruction of complex orbital floor defects is increasing and requires communication with an industry partner, which warrants investigation. Therefore, the aim of this study was to evaluate the effects of in-house training of engineers on such communication as well as to identify frequent sources of problems and their solutions for improvement of the implant-planning workflow. Methods We conducted a retrospective cross-sectional study and enrolled a sample of patents who had undergone orbital reconstruction with patient-specific implants between 2017 and 2020. The predictor variables were in-house training (additional training completed in hospital or not) and implant complexity (complex [multi-walled implants] vs. less complex [isolated orbital floor reconstructions]). The outcome variables were duration of communication, message length, and need for synchronous communication or modifications to the original design. Descriptive, uni-, and multivariate statistics were computed, and statistical significance was set at a p-value of < 0.05. Results This study included the data of 66 patients (48 men, 18 women, average age: 42.27 years). The complexity of the implant statistically significantly increased the duration of the communication (8.76 vs. 16.03 days; p = 0.004). In 72.73% the initial design had to be changed. Engineers trained in house required less communication to plan less-complex implants and generally needed fewer corrections to the original design (p = 0.020 and p = 0.036, respectively). Problems during planning were observed in 25.76% of the cases, with an insufficient diagnostic 3D dataset being the most common (15.15%). Conclusion In-house training of engineers is time-saving while planning the workflow for patient-specific implants, especially in less complex cases, given that design changes are not needed often. The high rate of datasets that were insufficient for planning patient-specific implants suggests that diagnostic 3D datasets should already meet the requirements for such planning.
Article
Background Communication failures disrupt physician workflow, lead to poor patient outcomes, and are associated with significant economic burden. To increase efficiency when contacting a team member in a hospital, we have designed an information directory app, InHouse Call. Objective This study aimed to describe the design of InHouse Call, objectively compare the usefulness of the app versus that of traditional methods (operator or pocket cards, etc), and determine its subjective usefulness through user surveys and a net promoter score (NPS). Methods This pilot study utilizing before-after trials was carried out at a tertiary academic hospital and involved 20 clinicians, including physiatrists, hospitalists, internal medicine and family medicine residents, and advanced practice providers/nurse practitioners/physician assistants. InHouse Call was designed to efficiently supply contact information to providers through a simple, user-friendly interface. The participants used InHouse Call in timed trials to contact a health care team member in the hospital via a telephone call. The effectiveness of InHouse Call in connecting the user with a contact in the hospital was measured through timed trials comparing the amount of time spent in attempting to make the connection using traditional methods versus the app. Usability was measured through exit surveys and NPS. Results The average time spent connecting to the correct contact using traditional methods was 59.5 seconds, compared to 13.8 seconds when using InHouse Call. The degree of variance when using traditional methods was 1544.2, compared to 19.7 with InHouse Call. A call made using the traditional methods deviated from the mean by 39.3 seconds, compared to 4.4 seconds when using InHouse Call. InHouse Call achieved an NPS of 95. Conclusions InHouse Call significantly reduced the average amount of time spent connecting with the correct contact as well as the variability to complete the task, thus proving to be the superior method of communication for health care providers. The app garnered a high NPS and positive subjective feedback.
Article
Background: Effective communication among healthcare teams is essential for ensuring handoff-related safety and quality care outcomes. Purpose: The aim of this project was to improve patient safety through the reduction of communication-related errors on an acute hemodialysis unit (AHU) in an academic medical center. A target was set to reduce by 50 percent the communication-related errors using strategies to improve teamwork and communication. Methods: Acute hemodialysis unit team members attended Clinical Team Training (CTT) informational sessions on teamwork and communication. A structured handoff tool was implemented in the AHU to improve nurse communication and reduce communication-related patient safety events. Descriptive statistics and comparison of means were conducted to assess the differences between preimplementation and postimplementation audit and safety event data. Results: There was a statistically significant difference between the preintervention and postintervention groups of handoff tool usage and completion as well as a consistent decrease in handoff-related safety events after implementation. Conclusions/implications: Findings suggest that CTT and a structured handoff tool used to guide nurse-to-nurse care transitions lead to a reduction in communication-related safety events during handoffs in an AHU.
Article
Objective Asynchronous messaging is an integral aspect of communication in clinical settings, but imposes additional work and potentially leads to inefficiency. The goal of this study was to describe the time spent using the electronic health record (EHR) to manage asynchronous communication to support breast cancer care coordination. Methods We analyzed 3 years of audit logs and secure messaging logs from the EHR for care team members involved in breast cancer care at Vanderbilt University Medical Center. To evaluate trends in EHR use, we combined log data into sequences of events that occurred within 15 minutes of any other event by the same employee about the same patient. Results Our cohort of 9,761 patients were the subject of 430,857 message threads by 7,194 employees over a 3-year period. Breast cancer care team members performed messaging actions in 37.5% of all EHR sessions, averaging 29.8 (standard deviation [SD] = 23.5) messaging sessions per day. Messaging sessions lasted an average of 1.1 (95% confidence interval: 0.99–1.24) minutes longer than nonmessaging sessions. On days when the cancer providers did not otherwise have clinical responsibilities, they still performed messaging actions in an average of 15 (SD = 11.9) sessions per day. Conclusion At our institution, clinical messaging occurred in 35% of all EHR sessions. Clinical messaging, sometimes viewed as a supporting task of clinical work, is important to delivering and coordinating care across roles. Measuring the electronic work of asynchronous communication among care team members affords the opportunity to systematically identify opportunities to improve employee workload.
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The development of evidence to demonstrate ‘value for money’ is regarded as an important step in facilitating the search for the optimal allocation of limited resources and has become an essential component in healthcare decision making. Real-world evidence collected from de-identified individuals throughout the continuum of healthcare represents the most valuable source in technology evaluation. However, in the European Union, the value assessment based on real-world data has become challenging as individuals have recently been given the right to have their personal data erased in the case of consent withdrawal or when the data are regarded as being no longer necessary. This act may limit the usefulness of data in the future as it may introduce information bias. Among healthcare stakeholders, this has become an important topic of discussion because it relates to the importance of data on one side and to the need for personal data protection on the other side, especially when it comes to “personal data related to the physical or mental health of a natural person, including the provision of health care services, which reveals information about his or her health status”. At the forefront of these discussions are data protection issues as well as the population’s trust in digital services. It seems that the new era has begun, where citizens and patients will have the ability to manage their personal or self-generated data. The European Commission has laid the groundwork for this paradigm shift that will steadily emerge in the coming years. To prepare for this change, we believe attention should be given to data security and other rules of data privacy. It has become increasingly important to ensure that individuals are properly introduced into complex environments with multiple sources of Big Data for clinical and behavioral purposes to provide an optimal balance between societal and individual benefits. In this article, a number of issues are considered and discussed, based upon the authors’ experience, with the aim of helping the reader better understand the implications of the use of Big Data and the importance of data protection in the coming years.
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This chapter discusses the adoption of Radio Frequency Identification (RFID) technologies as an emerging phenomenon enabling innovative mobile service applications. More specifically, it focuses on the healthcare sector by examining how RFID-enabled Real Time Location Systems (RTLS) can be used to enhance patient care processes while reducing costs of operations. Since different technological designs can be elaborated for a single application, there is a need for practitioners to have a better understanding of the technological options available on the market. Although much information is already available in the literature, many of it is not vendor neutral, resulting in more confusion for practitioners. This chapter addresses this gap by identifying specific comparison variables and using them to highlight the key differences between various RFID-enabled RTLS systems.
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This study investigated the use and impact of wireless communication technology developed by Vocera Communications and implemented at St Agnes Hospital, Baltimore, MD. The specific focus was on the impact of a newly installed component of the Vocera system, the Vocera Messaging Interface, which enables connectivity between third-party systems, such as a nurse call system. The results of the investigation of the nurse call integration confirmed that the use of the integrated communications system reduced overall mean time for completing a patient request by 51% across all observations when controlling for observation type. Furthermore, analysis of clinicians' usage of the system for different types of patient requests revealed that it enables the clinician to have more control in prioritizing and responding to requests according to the seriousness of the event. The study also exposed several "creative" and "evolving" impacts of the system that are discussed along with practical implications of the findings.