Critical conversations: A call for a nonprocedural “time out”

Abstract

BACKGROUND:Communication failures are an ongoing threat to patient safety. Procedural “time outs” were developed as a method to enhance communication and mitigate patient harm. Nonprocedural settings generate equal risks for communication failure, yet lack a similar communication tool or practice that can be applied, particularly with a patient‐driven focus.INNOVATION:Rapidly changing clinical states and care plans are common in the hospital setting, placing patients at risk for adverse events. Certain junctures allow for the highest potential of patient harm—at the time of admission, at a change in clinical condition, and at the time of discharge. Direct communication among healthcare providers at these junctures, which we have dubbed Critical Conversations, can provide an opportunity to clarify plans of care, address or anticipate concerns, and foster greater teamwork. Information exchanged during Critical Conversations includes a combination of checklist‐type items and more open‐ended questions but they ultimately create a structure and expectation for communication.LESSONS LEARNED:Integration of Critical Conversations into practice requires provider education and buy‐in, as well as expectations for them to occur. Monitoring adherence, capturing stories of success, and demonstrating effectiveness may enhance implementation and continuous improvement in the process.CONCLUSIONS:Communication tools designed to reduce the likelihood of patient harm remain a focus of patient safety efforts. Critical Conversations are an innovative communication tool, intervention, and policy that potentially limits communication failures at critical junctures to ensure high quality and safe patient care. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.

Communicating discharge instructions to patients: A survey of nurse, intern, and hospitalist practices

“…Fortunately, nurses and physicians rated verbal communication as the most desirable solution to share discharge education information. While not formally evaluated, one solution may be adoption of the previously described “critical conversation,” a structured format and a consistent time for communication that ensures both nurses and physicians understand what education needs to be provided to patients and by whom 20. The 13 discharge elements outlined in our study now provide a starting point for defining specific discussion points at discharge, delineation of who should communicate each element, and the basis for developing an operational discharge “time‐out.”…”

How is professionals’ information seeking shaped by workplace procedures? A study of healthcare clinicians

“…In most cases the timeout is a structured event that consists of walking through a checklist to verify that the treatment procedure about to be initiated is the one intended. However, Sehgal et al (2011) call for nonprocedural timeouts with a looser format and the goal of addressing questions such as "What do you anticipate happening in the next 24 hours?" The timeouts we investigate in the present study are an instance of such nonprocedural timeouts.…”

Air on the Side of Caution

“…Procedures are usually scheduled with little room for delay, and staff members may have work‐hour restrictions that put increased pressure on surgeons to complete procedures quickly and efficiently. Procedural time outs have been successful in helping team members develop a shared mental model at the start of the procedure . Any team member can initiate time‐out protocols at any time.…”