Communication in healthcare: a narrative review of the literature and practical recommendations

Abstract

SummaryObjectivesEffective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare.DesignNarrative literature review.MethodsA search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms ‘communication’, ‘primary health care’, ‘correspondence’, ‘patient safety’, ‘patient handoff’ and ‘continuity of patient care’. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorisation as original research, reviews, meta‐analyses or letters to the editor.ResultsA total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences.ConclusionThere is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow‐up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver.

Practicing handoffs early: Applying a clinical framework in the anatomy laboratory

“…One report suggests that a single patient may experience up to 15 handoffs (communications between caregivers regarding patients) per five-day hospital stay (Liston et al, 2014). Inadequate communication between nurses, clinical specialists, and caregivers is frequently reported as having a negative impact on patient care, patient outcomes, and healthcare costs (Leonard et al, 2004;Deneckere et al, 2012;Vermeir et al, 2015). Although many factors contribute to variability in handoff efficacy, a primary cause for these ineffective handoffs is the lack of handoff standardization (Burton et al, 2010;Berger et al, 2012;Carroll et al, 2012).…”

Conhecimento e uso de mecanismos para articulação clínica entre níveis em duas redes de atenção à saúde de Pernambuco, Brasil

“…A implementação dos mecanismos para articulação entre níveis ainda apresenta deficiências em ambas as redes. Essas apontam para possíveis entraves no desenvolvimento das políticas públicas brasileiras e na presença de falhas na organização das redes em saúde 15,16,17,18 .…”

“…Dentre os mecanismos de adaptação mútua, os formulários de referência e contrarreferência são considerados os principais mecanismos e os mais comuns para a integração dos diferentes níveis de atenção à saúde, e muitas vezes são os únicos existentes, principalmente em algumas regiões do Brasil 20,21,23 . No presente estudo, os médicos referiram o repasse de informações para o outro nível como sua principal finalidade, concordando com os estudos de Vermeir et al 18 , Durbin et al 24 , Reig-Mollá et al 22 . Vale destacar o papel administrativo desse formulário, finalidade também referida neste estudo e que pode estar relacionada à baixa qualidade de preenchimento, desvalorização de utilização e o uso apenas burocrático desse mecanismo 14,18 .…”

A multifaceted approach to improving the quality of ENT Emergency Clinic referrals

“…3 The time-sensitive nature of rapid access clinics requires effective communication between GPs, ED and ENT to provide an effective and patient-centred service. Poor communication when referring a patient to a rapid access clinic is an important quality and safety issue 4. In many departments, the initial referral request is received, triaged and booked by the junior ENT doctor in conjunction with the bookings office.…”