Holl J, Woods D, Fewster L, Ogata E, Makoul G, Weiss K; AcademyHealth. Meeting (2004 : San Diego, Calif.).

Abstr AcademyHealth Meet. 2004; 21: abstract no. 1930.

Feinberg School of Medicine, Northwestern University, Institute for Health Services Research and Policy Studies, 339 E. Chicago Avenue, Room 713, Chicago, IL 60611-3071 Tel. 312.503.0392 Fax 312.503 2936

RESEARCH OBJECTIVE: To describe effective and problematic clinician communication (communication between clinicians providing care for a patient) in hospital-based pediatric care and to identify, for problematic communication, the determinant characteristics related to patient safety risk. STUDY DESIGN: Clinicians were invited by an Ad Hoc Patient Safety Committee of a children's hospital to participate in a focus group. Focus groups, within each discipline (neurology, neurosurgery, surgery, intensive care unit (ICU), and emergency medicine), were convened by profession and professional level (nurse managers, staff nurses, attending physicians, fellow/ resident physicians and advanced practice nurses, nurse administrative coordinators). A standardized protocol, to assess the main means of communication (i.e., in-person, telephone, medical chart), to elicit discussion about effective and problematic communications, and to identify the characteristics of the communications, in particular those related to patient safety risk, was used. Focus group participants provided verbal consent and remained anonymous. The 90-minute focus groups were audio-taped and then, transcribed. Three investigators independently analyzed the data using a transcript-based approach to identify emerging themes and then, triangulate the findings to reach consensus. Basic characteristics (where, when, how, between whom, and what) were identified for all reported communications. Determinant characteristics for either effective or problematic communication with patient safety risk were sought. POPULATION STUDIED: Clinicians in a children's hospital. PRINCIPAL FINDINGS: Twenty focus groups were convened and included 65 clinicians with 2-7 participants per group. Daytime, in-person, team clinical communications (e.g. ward rounds, conferences) were reported as effective; those that included full participation of the entire team were described as most effective. All participants described problematic communication. Problematic communications with identified patient safety risks occurred: (1) during transitions (patient transfers between services or units, changes in attending/fellow/resident coverage, nursing shift changes); (2) in the scheduling of and getting studies and procedures performed; (3) for patients with complex medical/surgical conditions being cared for by multiple services; (4) for ICU patients managed by clinicians not primarily located in the ICU; (5) with non sub-specialized pediatric clinicians (nurses and physicians); and (6) with non-pediatric trained clinicians, particularly surgical clinicians, about medical management. CONCLUSIONS: This research provides some initial information about the characteristics of effective and problematic clinician communications in pediatric hospital-based medical care. Six distinct contexts were related to problematic clinician communications with identified patient safety risks. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Determinant characteristics of clinical communication that contribute to effective (i.e. daytime, team rounds) or problematic communication (i.e. transitions, non-pediatric trained clinicians) have been identified and should be useful in developing interventions to improve clinician communication. Further understanding of the contributions of additional factors such as knowledge, training, experience, resources, and organizational and spatial configuration is needed to reduce problematic clinical communication.

Publication Types:

• Meeting Abstracts

Keywords:

• Child
• Communication
• Focus Groups
• Hospitalization
• Hospitals, Pediatric
• Humans
• Intensive Care Units
• Life Support Care
• Logical Observation Identifiers Names and Codes
• Research
• Resuscitation Orders
• Terminal Care
• therapy
• hsrmtgs

UI: 103624964

From Meeting Abstracts