September 29, 2015

Doctors Create Risk from ER to Inpatient at Hospitals

You would think that doctor-to-doctor communication would be ideal and not create problems for patients. Not so, as this study points out. Apparently, when doctors are on duty, their communication skills are absence – big time. It is somewhat surprising that both the emergency and inpatient physicians say patient safety is at risk during hand-off from the emergency department to the hospital.

The problem during hand-off is ineffective communication. The findings were published online July 22 in the Journal of Hospital Medicine. Christopher J. Smith, M.D., from the University of Nebraska Medical Center College of Medicine in Omaha, and colleagues surveyed resident, fellow, and faculty physicians directly involved in admission hand-offs from emergency medicine and five medical admitting services at a 627-bed tertiary care academic medical center.

I think the key here is self-evident – academic medical center.

The study is based on responses from 94 admitting and 32 emergency medicine physicians. The researchers found that admitting physicians reported that vital clinical information was communicated less frequently for all content areas compared to emergency medicine physicians. Nearly all (94 percent) of emergency medicine physicians felt defensive at least "sometimes." Just under one-third of all respondents (29 percent) reported hand-off-related adverse events, most frequently related to ineffective communication. Sequential hand-offs were commonly reported for both emergency medicine and admitting services and 78 percent of physicians reported that these hand-offs negatively impact patient care.

"We identified several perceived barriers to safe inter-unit hand-off from the emergency department to the inpatient setting. Hand off-related adverse events, a pattern of conflicting physician perceptions, and frequent sequential hand-offs were of particular concern," the authors write. "Our findings support the need for collaborative efforts to improve interdisciplinary communication."

Apparently, one medical discipline uses a different language than another discipline and this is the cause of inefficient communication. When the administration does not recognize these problems, little attention is paid to communication problems and they don't improve. This happens often in academic centers and other hospitals with poor administrators.

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