From the days of Neanderthal drawings on cave walls to the sophisticated tools of cell phones, cable phones, and satellite phones, communication among humans has evolved at a dizzying pace. Or has it?

Communication among and between healthcare providers in the 21^st century may have actually devolved. Computers and smart phones have taken the place of interpersonal communication. While communication among healthcare providers has become more efficient, one can argue that it has become less safe for the patient. Gone are the days of consultants speaking directly to one another about a mutual patient. Now, physicians and mid-level providers read one another's notes either on paper or in a computerized medical record. Gone also are the days of nurses trading information on a patient between shifts. Shift report is either done through tape recordings or, again, via computerized notes. The rationale of decreased interpersonal communication between healthcare providers is “I am too busy.” Yes, we are constantly fighting the clock in our efforts to take care of patients in an environment that is wrought with “crossing Ts and dotting Is” to satisfy increasingly suffocating regulatory demands. Yet, while relying solely on digital communication, we are sacrificing the gain of subtle nuances of patient information that can be of supreme importance in their outcome. Family dynamics, psychosocial situations, or even a vague deviation from a normal exam may not be properly articulated to one another, and this can make a difference in the course of a patient's hospitalization.

Perhaps, the quality and quantity of interpersonal communication has suffered because of poorly defined roles and tasks,[ 4 ] “turf wars” among hospital departments/units, difficulty in socialization skills between professionals, or competing priorities among hospital staff. The problem of poor communication may be related to all of these factors. Irrespective of the underlying causes of communication breakdown between healthcare professionals, the adverse affect on patient outcome and development of tools to enhance and improve collaboration and communication is well documented in the literature.[ 1 2 ] Poor communication among healthcare providers also makes for a stressful workplace and encourages disruptive behavior among clinicians.[ 3 ]

There is no healthcare professional that is too important or too busy to speak or interact with a colleague, especially when it concerns a patient care issue. Leave egos and personal feelings at the door. Provide unencumbered quality patient care. Let us get back to the fundamentals of patient care and do the best we can for our patients all day, every day.

COUNTERACTING THE SILO EFFECT

If any of us think that it is beneath us to perform any hospital-based task, we are sorely mistaken. I cannot tell you how often, nearly on a daily basis, I wheel my own patient to an operating room (OR) to get there “on time” and “get going” rather than wait for transport to get them to the OR late. Similarly, if there is a second case in the OR, I grab a mop or do whatever needs to be done to get the next case started. This boils down to “breaking down the silo effect” that through one's behavior says to our colleagues/coworkers, “I am better or more important than you are.” We all have to grow up at some point; why not before it is too late and prior to alienating our OR teams so that they no longer want to play in “our sand box?”.

DIRECT CONTACT RATHER THAN COMMUNICATING THROUGH CHARTING OR PHONE MESSAGES WITH OTHER HEALTHCARE PROVIDERS

Don’t text me, call me; I want to speak to a real person to actually know and understand what is going on with a patient before I make any decision that may significantly impact their care. It does not take much time, but more useful information can be communicated in a few sentences than in a tweet or text. When speaking to someone on the telephone, it is also possible to glean from the attitude, demeanor, and choice of language, of the caller, that caller's state of mind and quite possibly, the gravity/complexity of the situation. How do you get that from a text message like Pt OK or Not OK?.

PATIENTS SUFFER FROM LACK OF DIRECT COMMUNICATION, PARTICULARLY FROM MDs

Just like communicating is a disappearing talent, so is the “obligation” so many older surgeons grew up with that inculcated in us the need to see “our own patients.” Surrogates, be they partners or PAs, will not do the trick. The patient wants to see your face, hear your voice; you can stop by the bedside and change the dressing and look at the chart, or just stand there and chew bubble gum; they want to know you care. That is why they chose you as their doctor. Furthermore, if you “eye-ball” your patient, one look is indeed worth a thousand words over the phone as there is so much information you can take in consciously and unconsciously all at the same time. Is the patient pale? Are they anemic? Are they short of breath/is their breathing labored/did they have a PE? The list goes on. It is this undefined clinical “expertise” that improves patient outcomes and, in some cases, save lives.

WHAT HAS HAPPENED TO THE CHANGE OF SHIFT HANDOVERS FOR NURSES, AIDES, PAS, AND MDs? DURATION, QUALITY?

In a paper that will shortly be published in Surgical Neurology International Spine Supplement entitled “Multidisciplinary hospital teams improve patient outcomes: A review,” I have discussed an article by Estryn-Behar MR, Milanini-Magny G, Chaumon E, Deslandes H, Fry C, Garcia F, et al. Shift change handovers and subsequent interruptions: Potential impacts on quality of care. J Patient Saf, 2014;10(1):29-44. A section in the article was entitled “Shift change handovers: Interruptions and time duration may negatively impact patient care.” I noted that in France, Estryn-Behar et al. utilized two surveys to assess the quality of shift changes/handovers (SCHs) between shifts; they looked at the frequency of interruptions and quality of care delivered to patients based on the analysis of questionnaires from 29 registered nurses (RNs), 18 nursing aides (NAs), and 14 full-time physicians. They noted, “shift change handovers (SCHs) are being reduced or eliminated in France to reduce staff costs.” They document how shortening SCHs reduced the “efficiency, team function, and quality of care” delivered by teams of medical specialists. They noted that RNs spent an average of 15 min on SCH at the start of their shifts, but only 13 min at the end of the shift; this included an unconscionable average of 50 interruptions that took up to 16% of the “working time.” For NAs, SCHs were similar; interruptions took up 10.3% of the working time; for physicians, it was the worst as SCHs were shorter or simply did not exist. Based on this study, the authors recommended better/longer change of shift communications with fewer interruptions would improve/maintain patient safety and quality of care. So why don’t we get back to basics?.

In short, I commend Mona Stecker on her commentary and look forward to a better future when more of us listen to each other rather than e-mail, text, or tweet.

COUNTERACTING THE SILO EFFECT

COUNTERACTING THE SILO EFFECT

COUNTERACTING THE SILO EFFECT

If any of us think that it is beneath us to perform any hospital-based task, we are sorely mistaken. I cannot tell you how often, nearly on a daily basis, I wheel my own patient to an operating room (OR) to get there “on time” and “get going” rather than wait for transport to get them to the OR late. Similarly, if there is a second case in the OR, I grab a mop or do whatever needs to be done to get the next case started. This boils down to “breaking down the silo effect” that through one's behavior says to our colleagues/coworkers, “I am better or more important than you are.” We all have to grow up at some point; why not before it is too late and prior to alienating our OR teams so that they no longer want to play in “our sand box?”.

COUNTERACTING THE SILO EFFECT

COUNTERACTING THE SILO EFFECT

DIRECT CONTACT RATHER THAN COMMUNICATING THROUGH CHARTING OR PHONE MESSAGES WITH OTHER HEALTHCARE PROVIDERS

DIRECT CONTACT RATHER THAN COMMUNICATING THROUGH CHARTING OR PHONE MESSAGES WITH OTHER HEALTHCARE PROVIDERS

DIRECT CONTACT RATHER THAN COMMUNICATING THROUGH CHARTING OR PHONE MESSAGES WITH OTHER HEALTHCARE PROVIDERS

Don’t text me, call me; I want to speak to a real person to actually know and understand what is going on with a patient before I make any decision that may significantly impact their care. It does not take much time, but more useful information can be communicated in a few sentences than in a tweet or text. When speaking to someone on the telephone, it is also possible to glean from the attitude, demeanor, and choice of language, of the caller, that caller's state of mind and quite possibly, the gravity/complexity of the situation. How do you get that from a text message like Pt OK or Not OK?.

DIRECT CONTACT RATHER THAN COMMUNICATING THROUGH CHARTING OR PHONE MESSAGES WITH OTHER HEALTHCARE PROVIDERS

DIRECT CONTACT RATHER THAN COMMUNICATING THROUGH CHARTING OR PHONE MESSAGES WITH OTHER HEALTHCARE PROVIDERS

PATIENTS SUFFER FROM LACK OF DIRECT COMMUNICATION, PARTICULARLY FROM MDs

PATIENTS SUFFER FROM LACK OF DIRECT COMMUNICATION, PARTICULARLY FROM MDs

PATIENTS SUFFER FROM LACK OF DIRECT COMMUNICATION, PARTICULARLY FROM MDs

Just like communicating is a disappearing talent, so is the “obligation” so many older surgeons grew up with that inculcated in us the need to see “our own patients.” Surrogates, be they partners or PAs, will not do the trick. The patient wants to see your face, hear your voice; you can stop by the bedside and change the dressing and look at the chart, or just stand there and chew bubble gum; they want to know you care. That is why they chose you as their doctor. Furthermore, if you “eye-ball” your patient, one look is indeed worth a thousand words over the phone as there is so much information you can take in consciously and unconsciously all at the same time. Is the patient pale? Are they anemic? Are they short of breath/is their breathing labored/did they have a PE? The list goes on. It is this undefined clinical “expertise” that improves patient outcomes and, in some cases, save lives.

PATIENTS SUFFER FROM LACK OF DIRECT COMMUNICATION, PARTICULARLY FROM MDs

PATIENTS SUFFER FROM LACK OF DIRECT COMMUNICATION, PARTICULARLY FROM MDs

WHAT HAS HAPPENED TO THE CHANGE OF SHIFT HANDOVERS FOR NURSES, AIDES, PAS, AND MDs? DURATION, QUALITY?

WHAT HAS HAPPENED TO THE CHANGE OF SHIFT HANDOVERS FOR NURSES, AIDES, PAS, AND MDs? DURATION, QUALITY?

WHAT HAS HAPPENED TO THE CHANGE OF SHIFT HANDOVERS FOR NURSES, AIDES, PAS, AND MDs? DURATION, QUALITY?

In a paper that will shortly be published in Surgical Neurology International Spine Supplement entitled “Multidisciplinary hospital teams improve patient outcomes: A review,” I have discussed an article by Estryn-Behar MR, Milanini-Magny G, Chaumon E, Deslandes H, Fry C, Garcia F, et al. Shift change handovers and subsequent interruptions: Potential impacts on quality of care. J Patient Saf, 2014;10(1):29-44. A section in the article was entitled “Shift change handovers: Interruptions and time duration may negatively impact patient care.” I noted that in France, Estryn-Behar et al. utilized two surveys to assess the quality of shift changes/handovers (SCHs) between shifts; they looked at the frequency of interruptions and quality of care delivered to patients based on the analysis of questionnaires from 29 registered nurses (RNs), 18 nursing aides (NAs), and 14 full-time physicians. They noted, “shift change handovers (SCHs) are being reduced or eliminated in France to reduce staff costs.” They document how shortening SCHs reduced the “efficiency, team function, and quality of care” delivered by teams of medical specialists. They noted that RNs spent an average of 15 min on SCH at the start of their shifts, but only 13 min at the end of the shift; this included an unconscionable average of 50 interruptions that took up to 16% of the “working time.” For NAs, SCHs were similar; interruptions took up 10.3% of the working time; for physicians, it was the worst as SCHs were shorter or simply did not exist. Based on this study, the authors recommended better/longer change of shift communications with fewer interruptions would improve/maintain patient safety and quality of care. So why don’t we get back to basics?.

WHAT HAS HAPPENED TO THE CHANGE OF SHIFT HANDOVERS FOR NURSES, AIDES, PAS, AND MDs? DURATION, QUALITY?

WHAT HAS HAPPENED TO THE CHANGE OF SHIFT HANDOVERS FOR NURSES, AIDES, PAS, AND MDs? DURATION, QUALITY?

In short, I commend Mona Stecker on her commentary and look forward to a better future when more of us listen to each other rather than e-mail, text, or tweet.

WHAT HAS HAPPENED TO THE CHANGE OF SHIFT HANDOVERS FOR NURSES, AIDES, PAS, AND MDs? DURATION, QUALITY?

References

1. Last accessed on 2014 Jun 06. Available from: http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances.Dingley_14.pdf .

2. Last accessed on 2014 Jun 06. Available from: http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is %20 Human %2019 99% 20% 20 report %20 brief. pdf .

3. Stecker M, Epstein N, Stecker MM. Analysis of inter-provider conflicts among healthcare providers. Surg Neurol Int. 2013. p. S375-82

4. Zwarenstein M, Reeves S. Knowledge translation and interprofessional collaboration: Where the rubber of evidence-based care hits the road of teamwork. J Contin Educ Health Prof. 2006. 26: 46-54