Medical professionals, activists, and policymakers rarely mention communication in the conversations about improving healthcare. But effective communication can be as lifesaving as timely surgery or powerful antibiotics. And poor disclosure is known to cause severe medical errors. Dr. Stephanie Sanderson, a nurse leader, explained some of the perils of miscommunication in healthcare.
"There were two nurses taking care of a critically ill COVID patient who was just put on ECMO in an isolation room with lots of noise. They were in full PPE wearing peppers. A nurse was outside the door, instructing them. The nurse outside the door mouthed to give 2000 units of heparin, but the nurses in the room thought he said 10,000, a potentially fatal dose."
So, what can your organization do? Here are 3 ways to improve communication in your healthcare organization to improve patient safety.
The first line of defense for patients is a communication technique that reaffirms what the patient is experiencing back to the provider, known as "teach-back." Often, healthcare workers trust that patients understand a diagnosis or treatment's implications. By having the patient reiterate the information in their own words, staff can guarantee that they processed it. Teach-back benefits are two-fold. First, it helps the patients advocate for themselves and navigate their treatment. Secondly, it ensures that patients can explain the information to their families or other providers, preventing misunderstandings and readmissions. Providers can also benefit from teach-back in treatment to avoid errors, like in Dr. Sanderson's example.
Healthcare providers work with a wide range of patients from different backgrounds with different needs. To adequately support all these individuals, providers must communicate honestly and avoid a discriminatory treatment environment. This means allowing for space in the conversation for patients to elaborate on their answers to provider questions. Hiring culturally competent staff protects patients, according to Tulane University, as does hiring interpreters if your hospital system frequently admits non-English speaking patients.
Dr. Christopher Landrigan, Chief of General Pediatrics at Boston Children's Hospital, notes that while the information gathering skills of physicians in hospitals are excellent, the hand-off of that information to others poses problems, especially for short-staffed hospitals.
From a patient perspective, they're sometimes driven crazy by being asked that same set of 20 questions by multiple people throughout the hospital. That initial data gathering is really standardized and exhaustive. Once you're through the hospital doors, however, there was really no structure by which information was passed from one doctor or nurse to the next or to the following shift change. And we found over a decade ago that that was leading to all kinds of medical errors and downstream problems.
Procedures for information hand-off equip all staff with the information they need to treat patients to the best of their ability. Systems like Dr. Landrigan's I-PASS universalize how doctors pass on EHRs using databases and iPads to avoid harm events. Healthcare organizations can partner with an outside vendor like I-PASS or develop their own mnemonic for information flow.