Stories about: Alisa Khan

Quick Note: Improving nighttime communications in the hospital

hospital communications

It’s now well known that breakdowns in communications are a leading cause of hospital medical errors, contributing to more than 60 percent of serious adverse events. Efforts such as I-PASS, which standardize communications during patient “handoffs,” have cut harmful medical errors by 30 percent.

But nighttime care, which evidence suggests is particularly error-prone, has been somewhat overlooked. Researchers at Boston Children’s Hospital, led by Alisa Khan, MD, MPH and Christopher Landrigan, MD, MPH, also wanted to incorporate parents’ experience, which had been missing in nighttime communications when families were asleep. In this study in Academic Pediatrics, Khan, Landrigan and colleagues prospectively evaluated a family-centered, multidisciplinary nighttime communication intervention.

The intervention was developed with input from parents, nurses and medical residents, as well as the hospital’s Family Advisory Council, residency program and nursing leadership. It consisted of a short, early-evening nurse–physician briefing session at about 7:30 p.m.; a bedside, family-centered huddle in I-PASS format between 8 and 9 p.m.; and, for selected patients, a nightly family update sheet.

The team prospectively followed patients, parents and nighttime providers on two pediatric inpatient units at Boston Children’s. They surveyed parents and providers both pre-intervention (May-October 2013) and post-intervention (May-October 2014) and compared their answers.

The intervention wasn’t fully adopted by staff, but it did improve some aspects of communication. Providers’ experience improved in several domains. Parents reported more of a sense of shared understanding with nurses and a better experience communicating with nighttime doctors.

But several communication parameters did not improve, highlighting the importance of continued family involvement in research and design of the interventions. The ongoing multicenter Patient and Family Centered I-PASS Study is now testing several enhancements.

Medical education for the modern world: Communication is key

communication hospital rounds residency medical training

While today’s doctors-in-training learn the most advanced clinical treatments and diagnostic methods, they may be missing out on something equally important: communication skills.

“Care delivery is moving towards a team-oriented model,” says Theodore Sectish, MD, director of education for the Boston Combined Residency Program (BRCP, a joint pediatric training program of Boston Children’s Hospital and Boston Medical Center). “We need to do a better job of training doctors to work with other clinicians and use standardized language.”

Poor communication can have a significant impact on patient outcomes. As Sectish points out, “Communication errors are the number one cause for sentinel events.” (A sentinel event is a death or serious injury in a health care setting that is unrelated to the natural course of the patient’s illness.)

And it’s not just discussions among clinicians that are important. Physicians must also be trained to translate complex medical information into a clear, comprehensible message for patients and families.

Recognizing that the era of maverick physicians working alone is over, hospital residency programs are developing initiatives to better prepare young doctors for the collaborative, patient-centered model of modern health care. …Read More

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