Barriers to effective, safe communication and workflow between nurses and non-consultant hospital doctors during out-of-hours

Brady, Anne Marie; Byrne, Gobnait; Quirke, Mary; Lynch, A; Ennis, Shauna; Bhangu, Jaspreet; Prendergast, Meabh

doi:10.1093/intqhc/mzx133

Cited by 10 publications

(5 citation statements)

References 28 publications

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“…Australian accreditation requirements currently contain limited assessment of ICC processes. Accreditation schemes also do not address communication at a technology level, despite years of clinical communication research demonstrating both negative and positive impact of specific clinical communication methods on the quality and safety of clinical communication practice (13), (14), (15, 16) (17).…”

Section: Discussionmentioning

confidence: 99%

“…The reported impact of the use of pagers was in alignment with previous studies that have highlighted the inefficiency associated with poor visibility and inaccuracy of pager allocation processes. Significant limitations in real-time communication occur using paging technology in an acute care setting (13) (14). Use of pagers not only raised concern from a communication timeliness perspective, but also from a communication quality perspective given key information is often omitted.…”

Section: Discussionmentioning

confidence: 99%

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Technology Based Challenges of Informal Clinical Communication in an Australian tertiary referral hospital – A mixed methods assessment of The Need for Change

Hart,

Hosking,

Todd

et al. 2024

Preprint

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BackgroundEffective communication is critical for safe, efficient clinical practice. Communication failures result in errors, misdiagnosis, inappropriate treatment and poor care. Communication errors also contribute to sentinel events and are an underlying factor in healthcare system complaints.Formal Clinical Communication (FCC) tools, such as ISBAR, improve patient outcomes. Governance of FCC is increasingly based around Electronic Medical Record (EMR), however much Informal clinical communication (ICC) occurs outside of the EMR.ICC involves disparate platforms including pagers, Short Message Service (SMS) texts, encrypted messaging apps, phones and local radio networks (eg Vocera). Documentation of ICC in the clinical record is low quality and not easily or routinely audited. ICC based on personal identities relies on accurate rosters, switchboard staff or secondary lists. Significant inefficiency and potential clinical risk can occur if the correct role to communicate with cannot be contacted quickly and easily.Local ProblemIn 2019, Austin Health performed a clinical governance assessment of ICC processes against National Standards for FCC. Further investigation and process mapping of ICC occurred in 2020. This indicated a paucity of relevant policy and procedures to govern ICC practices, with highly variable and overly complex processes.AimsTo document the technology used in informal communication between clinical and / or administrative staff.To document the self-perceived impact on staff of current communications methods.To document the self-perceived potential efficiency and safety impact of current communications methods.To identify key factors for consideration in organisational informal communication improvement.MethodMulti-disciplinary on-line staff cross-sectional survey using Microsoft Forms. The survey sought to confirm the range of informal communication methods in use and identify respondents’ perceptions of current multimodal communication technology issues and their inherent risks.Results115 self-selected clinical and administrative staff completed the survey. Multiple communication channels are used. Respondents noted high levels of frustration, delay, interruption and inefficiency. Desired communication improvements and use considerations were identified. Survey findings validated a prior clinical governance assessment of the existing ICC framework, and the need for technology reform.ConclusionsThere are gaps in governance standards for ICC, both locally and at a broader level. Sequential additions to technology platforms have created a high-risk communications environment. Staff perceptions of inefficiency, delay, frustration and a high level of patient safety risk were consistent across professions. This work informed the subsequent development of an enterprise platform dedicated to informal clinical communication.Key Message Summary BoxWhat is already known on this topic– Poor Communication practice contributes to preventable errors or adverse events in patient care. Use of structured handover tools such as ISBAR provide a framework to improve Formal Clinical Communication. Current multi-modal, communication technologies for Informal Clinical Communication are interruptive, inefficient, compound staff frustration and create potential for patient harm.What this study adds– We describe staff impressions of frustration, time wasting and potential for patient harm with existing multi-modal communications technologies together with a framework for informal communication policy enhancement.How this study might affect research, practice or policy– These findings provide a call for governance standards for informal clinical communication. We highlight the need for rationalisation of multi-modal communications technologies to reduce communication complexity and identify some key functional requirements for new technologies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Technology Based Challenges of Informal Clinical Communication in an Australian tertiary referral hospital – A mixed methods assessment of The Need for Change

Hart,

Hosking,

Todd

et al. 2024

Preprint

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“…É imprescindível uma boa comunicação entre as equipes e construção de fluxos eficazes. Percebe-se que algumas práticas usualmente utilizadas não contribuem para efetividade da comunicação, tornando necessário a utilização de estratégias metodológicas que viabilizem uma assistência segura (Brady et al, 2017).…”

Section: Discussionunclassified

Sistematização da transferência de cuidados em terapia intensiva pediátrica por meio da ferramenta SBAR

Matos¹,

Drews²,

Fróis³

et al. 2022

EJHR

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Introdução: A transferência de cuidados consiste na comunicação de informações clínicas do paciente para transferência de responsabilidade assistencial, sendo considerada um momento crítico, onde podem ocorrer falhas de comunicação. Objetivo: Relatar a experiência da implantação da ferramenta Situation-Background-Assessment-Recommendation (SBAR) para a padronização da comunicação entre profissionais durante a transição do cuidado. Método: Relato de experiência de atividades realizadas em hospital universitário, que abrangeu discussão e análise de eventos adversos decorrentes de falhas de comunicação. Resultados: As condutas no processo de transição do cuidado foram padronizadas por meio de elaboração e revisão de instrumentos; emprego da ferramenta SBAR nas transferências de pacientes entre turnos ou unidades e estabelecimento de fluxos de admissão e atendimento. Conclusão: A ferramenta propiciou a padronização de ações no processo de transição do cuidado, contribuindo para melhorias no processo de trabalho da equipe interdisciplinar e, consequentemente, para a segurança do paciente.

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“…The successful strategy rendered from this theme was the enhancement of communication with staff, different departments, and that Medicare information will prepare the hospital for changing Medicare regulations. Brady et al (2017) contended that effective communication and workflow provisions in a health care setting would minimize risk, enhance patient flow, and the quality of communication can positively impact patient safety. Similarly, Tingle Hospitalists can enhance communication efforts and professional competence levels by highlighting relevant experiences through sharing knowledge with colleagues by way of tutorial guidance and working meetings (Stadnicka, Kowal, Trojanowska, & Zarzycka, 2018).…”

Section: Emergent Theme 1: Remain Up-to-date With Medicare Changing Compliance Regulationsmentioning

confidence: 99%

Successful Billing Strategies in the Hospital Industry

Merritt-Myrick¹,

Harris²

2020

IJHRS

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This paper explores the negative impact of changing Medicare regulations have on hospital profitability. Findings indicate that the successful strategies billing managers could use to ensure Medicare reimbursement and profitability include remaining up to date with Medicare changing compliance regulations, enhancing communication with staff, multiple departments, and Medicare, and adopting a robust billing system and other systems that compliment billing. Since the implementation of changes, hospitals continued to foster criterion to ensure successful Medicare reimbursement, thereby remaining in operation to continue to support the healthcare needs of families in the local communities. The biggest obstacle for hospitals is the ever-revolving Medicare reform and the effects it has on lowering reimbursement for the hospital industry. Hospitals that are affected by reform report issues that relate to the Medicare Prospective Payment System (PPS), payment for performance, and value-based payments.

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Barriers to effective, safe communication and workflow between nurses and non-consultant hospital doctors during out-of-hours

Abstract: Enhancement of communication strategies between nurses and doctors has the potential to remove barriers to effective decision-making and patient flow.

Cited by 10 publications

References 28 publications

Technology Based Challenges of Informal Clinical Communication in an Australian tertiary referral hospital – A mixed methods assessment of The Need for Change

Technology Based Challenges of Informal Clinical Communication in an Australian tertiary referral hospital – A mixed methods assessment of The Need for Change

Sistematização da transferência de cuidados em terapia intensiva pediátrica por meio da ferramenta SBAR

Successful Billing Strategies in the Hospital Industry

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