Required to deliver care more efficiently and cost-effectively, hospitals and health care organizations can't afford to waste time or resources on inefficient clinician-to-clinician communications.
Yet, too many health care organizations still use cumbersome call centers, flow charts and Rolodexes to determine which clinician to call about a patient, what time to call and how best to contact that person. As noted in the 2012 Joint Commission Sentinel Event Data, communication breakdown is one of the causes of delays in treatment that result in a sentinel event.
Patient Safety and Satisfaction
In an examination of patient safety events at my hospital, Advocate Lutheran General Hospital in Park Ridge, Ill., my colleagues and I found that the majority were caused by communication issues. A frequent problem is a delay or difficulty in physicians reaching one another. Instituting a reliable method of contacting clinicians and getting responses seems like a simple task, but it is one of the most complex processes of any health system — and it became critical to the patient safety aspect of our workflow.
Take text messaging. Most providers are focused on the security of text messaging, which no one argues is important, but when a clinician sends a text message with critical, time-sensitive patient information, the patient suffers if it is sent to the wrong physician or is delivered an hour late.
We also know that if a patient has a concern and it takes hours for the nurse to contact a physician, that patient will have an unsatisfactory experience. There should be no reason clinicians can't get answers to make patients more comfortable as soon as possible. Delays prevent the caregivers from getting the information they need to make critical decisions on a patient's therapy and can have a significant impact on patient and clinician satisfaction.
Efficient Care and Care Transitions
When clinicians communicate as timely as possible, tests and procedures can be ordered properly and therapies can be started appropriately. This leads to more efficient care, and possibly to a reduced length of stay and other matters that are important to the hospital and the patient.
The timely transmission of information is also critical given all the transitions that patients experience throughout the course of their care. It's not just about discharges — it's how we are transitioning patients to a different level of care. When care transitions occur, hospitals need to make sure the right information is communicated so the next caregivers have everything they need for a seamless transition.
More Effective Consults
Enabling clinicians to communicate effectively about major aspects of therapy or diagnosis will become more necessary as networks of care expand. Among other critical communications, clinicians try to inform colleagues about a change in status, get a critical result from the lab or from an X-ray, or talk to a social worker about placement. We need to help them complete the communication in a timely and efficient manner, and in a way that's fundamentally different from what we've been doing for the last 30 years.
Tackling the Issue at Hand
Advocate Lutheran has learned some important lessons in addressing its communication problems that it can share with other organizations:
First, think about the workflow that will make sense for each group or department within your organization. Once you identify the current state of communications and the needs and concerns of clinicians, make improvements to processes as necessary. Then, after you have streamlined the process, seek technology partners that can cater to the new and improved workflow.
No matter which technology you choose to help you improve communication, approach the issue holistically. With texting, for example, think about how to secure all transmissions, not just smartphone texting. Think about the risks for every communication medium, the best way to manage that risk and how it plays into your organization's entire communications process. Whether it's a handwritten note, a text message, an email or a phone call, the communication needs to reach the clinician who is on call as quickly and securely as possible.
Finally, no solution you choose will be effective if physicians and nurses at your hospital aren't using it. While the information technology department certainly needs to get the technology up and running, no one is closer to the real flow of communication than the physicians and nurses who are interacting daily about the care of each patient. Ensure that they know their role in achieving the desired results and the benefit to them if they participate in effecting change.
Improving Patient Care
At Advocate Lutheran, we knew we needed to address the problem of clinician-to-clinician communication before we could evolve to provide higher levels of care and prepare for the changes ahead. Delays in clinician communication prevent the right caregivers from getting the information they need to make critical decisions on a patient's therapy, and have a significant impact on patient and clinician satisfaction. Similar issues likely vex most other facilities, and they must be solved without delay.
Michael McKenna, M.D., is the vice president of medical management and the chief medical officer of Advocate Lutheran General Hospital in Park Ridge, Ill. Leigh Ann Myers, R.N., M.S.N., vice president and chief clinical officer of PerfectServe in Knoxville, Tenn., contributed to this article.