Hospitalized Patients' Understanding of Their Plan of Care

O’Leary, Kevin J.; Kulkarni, Nita Shrikant; Landler, Matthew P.; Jeon, Jiyeon; Hahn, Katherine; Englert, Katherine M.; Williams, Mark

doi:10.4065/mcp.2009.0232

Cited by 88 publications

(89 citation statements)

References 27 publications

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“…7,8,10 They found that agreement between physicians and nurses was greatest for procedures planned (89%) and least for discharge date (64%)-almost identical to the proportions we observed. Agreement between physicians and patients was also poor, and similar to what we observed.…”

Section: Discussionsupporting

confidence: 65%

“…Agreement between physicians and patients was also poor, and similar to what we observed. 8 There was no communication reported between physicians and nurses 38% of the time; agreement was not associated with reported communication but duration of communication was not measured. 7 Our study has a number of limitations.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 However, it is not known how much time physicians actually spend communicating with nurses and other physicians, and more importantly, whether more time spent communicating is associated with higher levels of agreement regarding the plan of care or greater patient satisfaction. We performed a time-motion study to determine how much time hospitalists spend communicating with nurses, patients, other physicians, and families, and to test whether the amount of communication was related to patient satisfaction, or to agreement on the plan of care among physicians, nurses and patients.…”

Section: Introductionmentioning

confidence: 99%

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The Relationship Between Time Spent Communicating and Communication Outcomes on a Hospital Medicine Service

et al. 2011

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BACKGROUND: Quality care depends on effective communication between caregivers, but it is unknown whether time spent communicating is associated with communication outcomes. OBJECTIVE: To assess the association between time spent communicating, agreement on plan of care, and patient satisfaction. DESIGN: Time-motion study with cross-sectional survey. SETTING: Academic medical center. PARTICIPANTS: Physicians, patients, and nurses on a hospital medicine service. MEASUREMENTS: Hospitalists' forms of communication were timed with a stopwatch. Physician-nurse agreement on the plan of care and patient satisfaction with physician communication were assessed via survey. RESULTS: Eighteen hospitalists were observed caring for 379 patients. On average, physicians spent more time per patient on written than verbal communication (median: 9.2 min. vs. 6.3 min, p<0.001). Verbal communication was greatest with patients (mean time 5.3 min, range 0-37 min), then other physicians (1.4 min), families (1.1 min), nurses (1.1 min), and case managers (0.4 min). There was no verbal communication with nurses in 30% of cases. Nurses and physicians agreed most about planned procedures (87%), principal diagnosis (74%), tests ordered (73%), anticipated discharge date (69%) and least regarding medication changes (59%). There was no association between time spent communicating and agreement on plan of care. Among 123 patients who completed surveys (response rate 32%), time physicians spent talking to patients was not correlated with patients' satisfaction with physician communication (Pearson correlation coefficient = 0.09, p=0.30). CONCLUSIONS: Hospitalists vary in the amount of time they spend communicating, but we found no association between time spent and either patient satisfaction or nurse-physician agreement on plan of care.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Relationship Between Time Spent Communicating and Communication Outcomes on a Hospital Medicine Service

et al. 2011

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“…More specifically, we aimed to evaluate whether (1) hospital providers teach any content of these four basic self management skills ("four skills") as part of regular care to patients and their caregivers, and (2) whether information presented regarding any of the four skills' is understood and retained after the provider leaves the room. Secondarily, the project gathers information about standard or "control" care behaviors, such as hand washing on room entry or exist, [8] and quality of the provider-patient interaction [9] to capture a baseline rate for five "good clinical practice" activities.…”

Section: Introductionmentioning

confidence: 99%

Are we teaching our hospitalized patients self-management skills? Opportunities lost

Miotto

McNicoll

Butterfield

et al. 2015

JHA

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Background: In the U.S., 20% of medical hospital discharges are readmitted within 30 days. Non-medical intervention strategies, such as teaching four specific self-management skills, have demonstrated reduction in readmission risk by a third or more. Objective: To investigate whether hospitalized patients are taught or learn four basic self-management skills ("four skills") during routine clinical encounters. Methods: Design: Observational study from May to October 2012 in an academic teaching hospital. Participants: Consenting medical patients (aged 18 or over), their visitors or caregivers and their providers. Unit managers identified patients who would be discharged home and capable of learning the four skills. Interventions: A trained observer consented patients and monitored every provider encounter for mentioning and/or teaching of the four specific self-management skills' content for intervals of up to 6 hours during daytime shifts. After each encounter, the observer queried the patient and their caregiver to see what information relating to the four skills they retained and understood. Additionally, observers recorded patient demographics, native language, provider type, and major medical conditions present at the time of the encounter. Five control activities expected to occur routinely for each encounter were monitored for comparison. Main measures: Frequency of one of four self-management skill education events during patient-provider encounters. Results: We observed 56 patients over 326 encounters involving 117 physicians or medical students, 134 nurses or nursing students, and 163 hospital staff. Among 189 encounters with clinical staff (physicians or nurses), the four basic self-management skills were mentioned in 54 encounters (28.6%) but taught only in 12 encounters (6.3%). The comparison with control behaviors show a much higher proportion (hand washing 35%-41.3%, identified role 29.5%, asking for more question 19.1%). Physicians are more likely than nurses to discuss clinical conditions, medications, or any of the four skills' topics. Specific self-management teaching of patients led to better understanding of the these skills compared to just mentioning them (p = .03). Conclusions: Hospital providers rarely teach four basic self-management skills as part of regular care. Patients can learn this content while hospitalized which could potentially reduce 30-day readmission risk.

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“…19 With the adoption of the Accreditation Council for Graduate Medical Education (ACGME) duty hour restrictions, handoffs have increased, 20 and patients are often confused about who their physicians are and who is ''in charge.'' 21,22 While reduced hours certainly have positive consequences, residents have fewer opportunities to connect meaningfully with patients and witness the longitudinal course of illnesses. 11,12,23 Transitional and Alternate Care Settings From the ambulatory setting to hospitals, rehabilitation, extended care, and hospice facilities, transitions across care settings are moments of heightened patient vulnerability.…”

Section: The Current Reality: Discontinuities Of Carementioning

confidence: 99%

Continuity of Care as an Educational Goal but Failed Reality in Resident Training: Time to Innovate

Ellman¹,

Tobin²,

Stepczynski³

et al. 2016

Journal of Graduate Medical Education

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Hospitalized Patients' Understanding of Their Plan of Care

Cited by 88 publications

References 27 publications

The Relationship Between Time Spent Communicating and Communication Outcomes on a Hospital Medicine Service

The Relationship Between Time Spent Communicating and Communication Outcomes on a Hospital Medicine Service

Are we teaching our hospitalized patients self-management skills? Opportunities lost

Continuity of Care as an Educational Goal but Failed Reality in Resident Training: Time to Innovate

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