Communication is important in providing top quality patient care. Any breakdowns in communication can lead to serious problems, such as patient complications or deaths. A new report shows just how much poor communication impacts hospital care.
The report, written by patient safety experts CRICO Strategies, discusses how miscommunication affects healthcare delivery.
CRICO looked at over 23,000 medical malpractice lawsuits and claims where patients suffered some form of harm. Out of all these cases, it identified over 7,000 where the problem was directly caused by miscommunication of certain facts, figures and findings.
According to the report, communication errors don’t just happen because someone doesn’t fully understand what a doctor or nurse is saying. Errors “occur because information is unrecorded, misdirected, never received, never retrieved or ignored.”
In all, CRICO estimated these errors cost the healthcare system $1.7 billion, including the price tag of hefty malpractice payouts for serious injury or death.
The errors occurred in the inpatient setting, the outpatient setting and the emergency department. Injuries to the patient caused by these errors were mostly of high and medium severity. Out of all the high-severity injury cases reviewed, 37% involved some sort of communication failure.
Over a quarter of malpractice cases involving surgery, and 32% of all nursing cases, were caused by a lack of thorough communication in some aspect of patient care.
Communication problems happened between providers, as well as between providers and patients. In some cases, a combination of both issues caused patient harm.
The most common provider-to-provider communication breakdowns were:
- miscommunication about the patient’s condition
- poor documentation, and
- failure to read the patient’s medical record.
And common provider-to-patient communication issues involved:
- inadequate informed consent
- unsympathetic response to a patient’s complaint
- inadequate education (such as about medications)
- incomplete follow-up instructions
- no or wrong information given to patient, and
- miscommunication due to language barrier.
Causes of breakdowns
While each case is different, CRICO identified several common problems that play a role in communication breakdowns in hospitals, such as workload pressure, problems with a hospital’s electronic health records (EHR) system, workplace culture – and even just distractions.
There are also unexpected circumstances that cause communication breakdowns – including familiarity. CRICO cites a study that found more communication breakdowns occur among people who know each other than between strangers. Reason: People think they can use shortcuts in how they express themselves because they assume the other party will understand.
However, this assumption can be deadly in the hospital setting.
How to fight back
There are several strategies hospitals have successfully used to fight the costly, dangerous problem of miscommunication.
Besides regular teamwork training with a focus on making sure clinicians communicate clearly and directly with each other, some have tried to eliminate miscommunications in an area where they commonly occur: patient handoffs.
Hospitals have cut down on misinformation using the I-PASS method during shift changes and other transitions of care. I-PASS is a mnemonic facilities can adapt to ensure all of the following information is communicated when providers perform handoffs:
- illness severity
- patient summary
- action list
- situation awareness and contingency planning
- synthesis by receiver
Nine hospitals used this strategy as part of a research study to boost patient safety. These facilities saw a 30% decrease in preventable medical errors due to improved communication of key information.
Other ways hospitals have improved communication include:
- role playing and safety drills so providers can practice the communication skills they learned in training
- direct observation of procedures by department chairs to identify and correct gaps in teamwork, and
- EHR updates that help doctors better document important details about the patient’s condition.
Whatever tactic your facility chooses, it needs to make sure all forms of communication involving clinicians are top-notch. Developing and enhancing providers’ written and oral communication skills can prevent big errors that both hurt patients and bring negative attention to your hospital.