It’s important for hospitalists to stop and understand where other providers are coming from before they try to make themselves understood.
—Tracy Cardin, ACNP-BC, nurse practitioner, hospital medicine section, University of Chicago Medical Center, Team Hospitalist member
As leaders of patient-care teams, hospitalists communicate with a wide array of care providers—case managers, nurses, pharmacists, trainees, and social workers to name a few. When the number of regular contacts increases, so, too, does the chance for miscommunication.
“Hospitalists are very non-discriminatory. We can miscommunicate with anybody,” says Jack Percelay, MD, FAAP, MP, SFHM, a pediatric hospitalist at Hunterdon Medical Center in New York City. “We all get burned at different times and that reminds us of the need to be careful, redundant, and very specific when communicating.”
How a hospitalist expresses important information with members of the care team affects the quality of patient care and the efficiency with which it’s delivered, says Sandeep Sachdeva, MD, FACP, a hospitalist at Swedish Medical Center in Seattle and a clinical assistant professor of medicine at the University of Washington. The following five scenarios demonstrate general areas of hospitalist-provider miscommunication and corrective actions that can be taken to reduce communication errors.
Scenario: An attending hospitalist quickly discusses with residents the plan of care for several patients and doesn’t invite questions, assuming the residents understand everything he is saying. For the most part, the residents comprehend the information, but some are uncertain on the more complex points. Nonetheless, no one asks questions for fear of being perceived as unintelligent or unprepared.
Corrective action: Miscommunication often is not about what’s said, but about what’s unsaid, says Sandeep Sachdeva, MD, FACP, a hospitalist at Swedish Medical Center in Seattle and a clinical assistant professor of medicine at the University of Washington. Opportunities for communication are missed when hierarchical barriers lead more experienced physicians to skip over information they believe others know and less experienced physicians to refrain from asking questions, he says.
Adopting a team approach that encourages inquiry helps to open lines of communication between attendings and residents, Dr. Sachdeva says. “In my experience, the more questions I ask not only helps me, but helps the other person, too,” he says. “The intellectual back and forth stimulates the mind and fosters collaboration.”
To facilitate teamwork, hospitalists must be respectful of other people’s experience, Dr. Percelay says.
“A hospitalist might feel his knowledge area is up to a level 8 out of 10, but he has to realize that something very clear to him won’t be as clear to someone used to working at the 5 or 6 level,” he says. “The hospitalist really needs to talk out loud and explain the situation to make sure everyone is on the same page.”
Seek to Understand
Scenario: A nurse practitioner comprehensively communicates the plan of care to a patient and her family. A short time later, and before advising the nurse practitioner, a hospitalist visits the patient and outlines substantial changes to the plan. The nurse practitioner loses credibility with the patient and family, and throughout the rest of the hospital stay the patient questions the accuracy of the information the nurse practitioner provided. The patient also wonders if the entire HM team is on the same page and providing a high level of care.
Corrective action: A hospitalist should communicate changes in a patient’s plan of care with all pertinent care-team members before informing the patient or the family, says Tracy Cardin, ACNP-BC, a nurse practitioner in the hospital medicine section at University of Chicago Medical Center and Team Hospitalist member.