Communication Failures: An Insidious Contributor to Medical Mishaps

Sutcliffe, Kathleen M.; Lewton, Elizabeth; Rosenthal, Marilynn M.

doi:10.1097/00001888-200402000-00019

Cited by 856 publications

(578 citation statements)

References 12 publications

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“…In addition, research suggests the need for improved teamwork and communication in neonatal intensive care, 2,3,16 emergency departments, 10 the operating room, 17,18 trauma resuscitation [19][20][21] and among residents of all disciplines. 22 Despite this interest and research, two recent reviews concluded that no studies have shown that team training can improve teamwork and the quality of care, 11,12 and a cluster randomized trial of team training for labor and delivery teams did not find significant changes in the process of care or outcome measures. 23 Thus, knowledge about how to improve team behavior appears to be in its infancy.…”

Section: Discussionmentioning

confidence: 99%

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

et al. 2007

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Objective: To add a team training and human error curriculum to the Neonatal Resuscitation Program (NRP) and measure its effect on teamwork. We hypothesized that teams that received the new course would exhibit more teamwork behaviors than those in the standard NRP course.Study design: Interns were randomized to receive NRP with team training or standard NRP, then video recorded when they performed simulated resuscitations at the end of the day-long course. Outcomes were assessed by observers blinded to study arm allocation and included the frequency or duration of six team behaviors: inquiry, information sharing, assertion, evaluation of plans, workload management and vigilance. IntroductionThe Neonatal Resuscitation Program (NRP) is the standard curriculum used to teach caregivers how to treat newborns in the delivery room. Worldwide, the NRP could improve outcomes of thousands of newborns per year. 1 However, approximately 30% of NRP steps are not performed or performed incorrectly, 2,3 and pediatric residents often fail to intubate infants correctly. 4 Neonatal resuscitation should be a team activity that involves at least two people who work together to achieve a shared goal. 5 Breakdowns in teamwork may contribute to the quality problems noted above. For example, team behaviors are correlated with the quality of neonatal resuscitation, 3 communication breakdowns are root cause of 72% of perinatal deaths and injuries, 6 perceptions of effective teamwork are correlated with less burnout and fewer delays in labor and delivery, 7 and there is broad consensus from expert groups and researchers that measuring and improving teamwork will help improve the quality of health care. [8][9][10] However, none of the nine lessons in the NRP textbook 1 includes instruction about teamwork, in part because no studies have shown that team training can improve either teamwork or the quality of health care. 11,12 Therefore, we conducted a study with two specific aims: (1) to incorporate teamwork skills and information about human error into the 1-day NRP training program for interns and (2) to randomize interns to this new version of NRP or the standard NRP and measure the effects on teamwork during the simulated resuscitations at the end of the day. We hypothesized that it would be feasible to add the teamwork training to the 1-day NRP course, and that interns who were randomized to the NRP course with team training would exhibit more teamwork behaviors during the simulated resuscitation than would the interns in the standard NRP course.

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Section: Discussionmentioning

confidence: 99%

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

et al. 2007

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“…[1][2][3][4][5] Yet, research documents that nurses and physicians in the hospital do not communicate consistently and frequently disagree on their patients' plans of care. 6,7 Nurses and physicians have discrepant views on the quality of collaboration according to research conducted in operating rooms (ORs), intensive care units (ICUs), and general medical units.…”

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Improving teamwork: Impact of structured interdisciplinary rounds on a hospitalist unit

O’Leary

Haviley

Slade

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Effective collaboration and teamwork is essential in providing safe and effective care. Research reveals deficiencies in teamwork on medical units involving hospitalists.OBJECTIVE:The aim of this study was to assess the impact of an intervention, Structured Inter‐Disciplinary Rounds (SIDR), on nurses' ratings of collaboration and teamwork.METHODS:The study was a controlled trial involving an intervention and control hospitalist unit. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. We asked nurses to rate the quality of communication and collaboration with hospitalists using a 5‐point ordinal scale. We also assessed teamwork and safety climate using a validated instrument. Multivariable regression analyses were used to assess the impact on length of stay (LOS) and cost using both a concurrent and historic control.RESULTS:A total of 49 of 58 (84%) nurses completed surveys. A larger percentage of nurses rated the quality of communication and collaboration with hospitalists as high or very high on the intervention unit compared to the control unit (80% vs. 54%; P = 0.05). Nurses also rated the teamwork and safety climate significantly higher on the intervention unit (P = 0.008 and P = 0.03 for teamwork and safety climate, respectively). Multivariable analyses demonstrated no difference in the adjusted LOS and an inconsistent effect on cost.CONCLUSIONS:SIDR had a positive effect on nurses' ratings of collaboration and teamwork on a hospitalist unit, yet no impact on LOS and cost. Further study is required to assess the impact of SIDR on patient safety measures. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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“…Communication failure is a major contributor to medical errors. 2,3 Recognizing such findings, a growing body of literature addresses handoff techniques for learners. [4][5][6][7] Vidyarthi described the handoff process as ''traditionally informal, unstructured, and idiosyncratic,'' 4 and many believe efforts to formalize and structure this process are important for patient safety.…”

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confidence: 99%

Gaining efficiency and satisfaction in the handoff process

Burton

Kashiwagi

Kirkland

et al. 2010

Journal of Hospital Medicine

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BACKGROUND:Handoffs, or transfers of patient care responsibility, occur frequently on hospitalist teams. The reliability and efficiency of the handoff process is a national and local concern. Most studies in the literature regard physicians‐in‐training. We studied the morning handoff process of hospitalist teams comprised of staff physicians and nurse practitioner and/or physician assistants.METHODS:An improvement team observed morning handoffs. Four problems were identified: unpredictable start and finish times, inefficiency, poor environment (hallway noise and distracting in‐room conversations), and poor communication. The team restructured the process and observed post‐intervention behavior at 15 and 90 days. A participant‐provider survey was conducted before and after the intervention regarding wasted time, total time‐in‐report, and satisfaction with the process.RESULTS:Pre‐intervention 60.5% of providers (23/38) believed morning handoff was performed in a timely fashion compared to 100% (15/15) post‐intervention (P = 0.005). Average time spent in morning report was 11 minutes, compared to 5 minutes after the intervention (P < 0.0028). Pre‐intervention 6.5 minutes were believed wasteful, compared to 0.5 minutes post‐intervention (P < 0.0001).CONCLUSIONS:This study identifies deficiencies in the handoff process that were addressed by enhancing the physical environment (smaller room, noise reduction, closed door), assigned seating (visual cues by table tent cards), non‐clinicians providing printed materials, standardization of written updates, team times (consistent & precise daily time for each team report), culture change including deference of attention to team receiving report with opportunity for questions, and minimization of side conversations. This intervention package resulted in an improvement in satisfaction and timeliness of clinicians involved. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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Communication Failures: An Insidious Contributor to Medical Mishaps

Cited by 856 publications

References 12 publications

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial

Improving teamwork: Impact of structured interdisciplinary rounds on a hospitalist unit

Gaining efficiency and satisfaction in the handoff process

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