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Say What?


Research—not to mention common sense—shows that good communication between caregivers is essential for patient safety, particularly communication among doctors and nursing staff.

In the session “Nurse-Hospitalist Communication,” presenters Win Whitcomb, MD, Mercy Medical Center in Springfield, Mass., and Sally Szumlas, RN, MS, University of Chicago, each told their side of the story, outlining perceived problems and best practices for clear communications between MDs and RNs.

The RN Perspective

Szumlas began with an overview of the problem. “Nurses, through training, tend to be very descriptive, while MDs want to hear succinct information only,” she said. “This can lead to frustration, missed information, and poor communication.”

At the University of Chicago, a project focused on nurse-physician communications took the following steps to improve communication: The hospital instituted multidisciplinary rounding using the call light—indicating that when the physician reaches the patient’s bedside, he or she pushes the call light and the nurse will join if possible. The hospital also implemented the SBAR form—with sections for the nurse to fill in situation, background, assessment, and recommendations. This form ensures a standardized approach to critical communication, particularly when the nurse phones a physician with questions or patient information.

Szumlas concluded by listing common communication roadblocks, including a misunderstanding of roles, real and perceived power differentials, gender and ethnic differences, and differences in styles of communication.

The Hospitalist’s Viewpoint

Win Whitcomb, MD

Dr. Whitcomb presented the hospitalist’s view of nurse-MD communications, saying, “My sense is that collaborating with nurses is among the most satisfying thing we do.” However, he went on, there are common problems with communications between the two groups. “Interruptions are too frequent,” he pointed out. “We still practice telephone medicine too frequently, and nurses are not always available—they’re busy.”

And the addition of hospitalists has created communication problems that didn’t exist before. These include nurses not knowing which hospitalist to contact, or not being able to reach the hospitalist on duty. Nurses can be stuck bringing a hospitalist who’s starting a new shift up to speed on patients, or placating family members who want to see the unavailable hospitalist immediately.

Dr. Whitcomb offered an action plan hospital medicine programs can implement immediately: He suggested establishing a forum for improving nurse-physician communications, using dialogue, and creating action plans. In addition to this forum, the nurse leader and the hospital medicine director should meet regularly. You should also integrate nursing staff into daily rounds “any way that you can. Interdisciplinary rounds are very difficult,” Dr. Whitcomb admitted. “Everyone is busy.”

Additionally, hospital medicine programs should establish standards for team communication. “Seriously consider a daily goals sheet,” urged Dr. Whitcomb, “one for nurses and hospitalists to use to communicate their plan of care.” Adopt an SBAR tool for critical communications, and create an RN-MD communication log sheet on each patient’s chart. “This can replace the ‘stickies’ I find on the front the chart that aren’t dated or signed,” pointed out Dr. Whitcomb.

Hospitalists can also smooth communication problems by using a concise but detailed patient sign-out at shift changes; and nocturnists should add routine rounds to proactively address issues. Nurses, on the other hand, can help by pooling non-urgent calls during the night and, when appropriate, using text messaging when a quick return call is not critical.

Other basic best practices include distributing the hospitalists’ census to all nursing units by 8 a.m. (as well as to the receptionist), placing the hospitalist schedule at all nursing units, ensuring that day hospitalists leave their beepers on until designated times around the end of their shift, and dedicating a universal pager for rapid responses, codes, emergencies, and coverage questions. TH

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