Stories about: doctor-patient communications

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.

On being present, not perfect

Just over a year ago, I was invited to give a TED Talk as part of Boston Children’s first-ever TEDxLongwood event. As exciting as the invitation was, it was also daunting. After all, TED Talks are supposed to be insightful, profound, personal, funny, and entertaining- and all of this in less than 18 minutes! Oh, and let’s not forget the requisite “story arc” and unexpected, memorable ending. On more than one occasion, I thought, just what had I gotten myself into? Is it too late to bail? …Read More

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Communication breakdown: How can we get patients and doctors talking again?

doctor-patient communications Dennis Rosen

The words “First, do no harm” form the core of every doctor’s approach to medicine. The first step to doing no harm, though, is ensuring that both doctor and patient are on the same page regarding a patient’s health. Both must understand the nature of an illness, the treatment options, the goals of care and how they fit with both the doctor’s and the patient’s values and beliefs before care is provided.

Reaching that point requires a close relationship between doctor and patient. However, the communication on which such relationships are founded is all too often lacking, creating obstacles to effective care, increasing health care costs and even causing patients harm.

Notes sat down with Dennis Rosen, MD, a Boston Children’s Hospital pulmonologist and author of “Vital Communications,” a recent book about doctor-patient communications, to talk about how the doctor-patient relationship has changed and how to bring effective communication back as a priority. …Read More

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