It's common for patients to feel socially stranded in the intensive care unit, unable to communicate because of a ventilator or artificial airway. With the goal of improving interaction with the estimated 800,000 critically ill patients unable to speak each year because of medical devices blocking the way, researchers from the Ohio State University and the University of Pittsburgh created an online training course with multiple tools and approaches.

Developed through research funded by the Robert Wood Johnson Foundation, the Study of Patient-Nurse Effectiveness with Assisted Communication Strategies, or SPEACS, program includes techniques to help patients better understand questions, ways to assess their ability to communicate and video demonstrations of strategies in action.

Small communication errors can produce big negative outcomes. In one SPEACS example, a patient unable to speak clearly who mouthed the word "pants" — because he was cold — received pain medications because it sounded like "pain." Such a simple misunderstanding can lead to a prolonged time on mechanical ventilation, and the possible adverse effects that come with it, says Mary Beth Happ, R.N., a study leader and director for the Center of Excellence in Critical and Complex Care at Ohio State.

"That's not a mistake or error that you would be able to apprehend in any data system that we have," she says. "You really have to be able to understand the patient to know that you misunderstood. It's a legitimate and certainly plausible interpretation to think the patient is in pain, but it's the wrong one."

These issues may not always rise to the attention of the hospital CEO, but they should, says Holly Lorenz, R.N., chief nursing officer of the University of Pittsburgh Medical Center, where the SPEACS program was tested. Clinical leaders should frame it as a quality initiative, one that could impact patient satisfaction survey scores and, ultimately, the bottom line. "CNOs have to know their audience within the C-suite, how they can present something like this and how it really does tie to the strategic initiatives of the hospital," Lorenz says.

Adopting SPEACS strategies in a hospital setting can take some focus, says Kathryn Garrett, a speech therapist in Pittsburgh who helped to develop the intervention, and now works in private practice. She urges hospital leaders to put together a targeted team to tackle the issue, and not to assume that one solution is going to work for every patient. "There is no 'the' strategy," Garrett says. "These folks are just so different. Some things work universally, but few. Every client really needs that individualized assessment."