Communication and Shared Understanding Between Parents and Resident-Physicians at Night

Abstract

BACKGROUND AND OBJECTIVE Communication breakdowns between members of the health care team compromise patient safety and experience. Communication breakdowns with parents, an important but often overlooked part of the health care team, are understudied. Parents may play a particularly important role in nighttime care given decreased staffing and inadequate transitions of care at night. We studied communication breakdowns evidenced by lack of shared understanding between parents and night-team residents about the reason for admission and care plan. METHODS We conducted a prospective cohort study of parents (n = 286) and night-team senior residents (n = 34) from May 1, 2013 to October 31, 2013. Parents and residents rated communication and described patients’ reason for admission, overall plan, and overnight plan. Two physician investigators independently reviewed (κ = 0.63) resident-parent dyads, assigned subsequently dichotomized 4-point overall agreement scores, and rated plan complexity. Using clustered logistic regression, we evaluated relationships among demographics, plan complexity, and shared understanding. We also examined resident and parent perceptions of shared understanding. RESULTS We analyzed data from 257 parent-resident dyads. Among these, 45.1% were rated as lacking shared understanding (agreement score = 1 or 2). In multivariate analysis, higher plan complexity (P < .001) and length of stay (P = .002) were associated with lack of shared understanding; lower parental education was a borderline predictor (P = .05). When surveyed, parents and residents reported that they shared an understanding with one another about care plans in 86.0% and 73.1% of cases, respectively. CONCLUSIONS Parents and night-team residents frequently lack shared understanding. Family-centered care initiatives to improve parent-provider communication and shared understanding may help empower parents as partners in safe and high-quality nighttime care.

Parent-Provider Miscommunications in Hospitalized Children

“…We previously found that parent-provider communication breakdowns evidenced by lack of shared understanding about inpatient care plans occurred in 45.1% of parent-resident dyads. 25 We also found that quality of parent-provider nighttime communication was associated with overall hospital experience. 10 We additionally found that parents provided unique information about hospital safety events, particularly communication-related ones.…”

“…In a previous study in the same units, we found that 73.1% of providers reported they shared an understanding with parents about the care plan; however, when objectively rated, only 54.9% of provider-parent dyads were rated as having a shared understanding. 25 Additionally, multiple caregivers who do not communicate fully with one another may be present during the hospitalization.…”

Parental Management of Discharge Instructions: A Systematic Review

“…Knowing to look for these signs and symptoms as part of a contingency plan have been highlighted as an essential piece of the hospital-tohome transition. 1 they are often unaware of signs to look out for while their children are hospitalized, 97 providing further evidence that families need additional education in this area.…”

Inpatients Sign On

“…By increasing patient access to health information, inpatient portals have the potential to enhance patient recognition of their providers and knowledge of their care plan, an area ripe for improvement. 23,24 Information made available to patients through inpatient portals may also augment face-to-face communication with providers. 6 For example, patient-provider shared decision-making during patient-centered rounds may be improved if test results were available to patients through inpatient portals beforehand.…”