Team Communication: It's About Patient Safety

Abstract

The single biggest problem in communication is the illusion that it has taken place."-George Bernard ShawThe article by Weaver et al 1 in this issue of Journal of Oncology Practice provides an important reminder to oncologists who lead interprofessional teams that opportunities to improve team communication remain. Studies in a variety of settings have concluded that communication affects the quality of patient care, team satisfaction, and nursing turnover rates. 2 The disconnect in perception of communication between physicians and their nursing colleagues is significant and well documented in the literature, 3-6 so much so that it is surprising that studies are still taking place. As Weaver et al describe, strong team collaboration supports patient safety on many levels. The challenge for researchers in this field is to replicate the results of interventions already implemented at a few institutions in a multicenter study. Other potential research could examine questions related to the types and breadth of communication. In the past 10 years, tools such as texting, Vocera, and electronic medical records (EMRs) have added to the complexity of team communication.Fifteen years ago, the Institute of Medicine challenged providers to embrace the need to radically improve how patient care is delivered by "hard wiring" safety into our culture. 7 Initiatives such as checklists, rapid response teams, medication reconciliation, and hand-off procedures all contribute to improving patient safety outcomes. 8 An example of a national effort is the Agency for Healthcare Research and Quality program, "On the Cusp: Stop BSI Project," which was able to show a 44% decrease in central line blood stream infections. 8 Yet we continue to witness communication breakdowns that adversely affect patient outcomes. Most recently, the highly publicized Ebola outbreak brought to light a gap in communication when a nurse asked all the right questions and documented the answers in the EMR, yet a patient who should have been flagged as potentially infected was allowed to leave the emergency room before the Ebola risk was noted. 9 Most nurses and physicians would not be surprised by this event; electronic records are not always supportive of interdisciplinary communication.As Weaver et al 1 point out, the impact of poor interprofessional team communication on an oncology inpatient unit and the resulting quality outcomes are less understood. Although research in the specialty of inpatient oncology is still needed, studies in a wide range of "dynamic domain" specialties such as operating rooms, intensive care and trauma units, and emergency departments have produced a body of literature that identifies some specific barriers to effective communication. 4-6,10,11 Thomas et al 6 described barriers related to suboptimal conflict resolution and interpersonal communications skills. Other findings go on to identify status, authority, responsibilities, gender, training, and nurse/physician cultures as factors that influence effective communication. 5,6,12...

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