C. Fischer2, V. Rendell3, E. Winslow3 2University Of Wisconsin,School Of Medicine And Public Health,Madison, WI, USA 3University Of Wisconsin,Department Of Surgery/School Of Medicine And Public Health,Madison, WI, USA
Introduction: Communication gaps have been tied to medical errors, treatment delays, and patient dissatisfaction. The hospital consultation process is particularly vulnerable to communication gaps, but these gaps have not been well studied. We aimed to evaluate which specific communication issues lend weaknesses to the consult process from the perspective of providers and patients.
Methods: As part of an existing quality improvement project at our institution, we evaluated inpatient communication event reports from clinicians and staff from February 2017 to January 2018. We also performed semi-structured interviews of inpatients who had received either a medical oncology (MO) or general surgery (GS) consult. Interviews were transcribed. A qualitative content analysis was performed on the event reports and interviews to uncover themes illustrating consult communication challenges. Themes were enumerated, and percentages determined out of total event reports or total interviews as appropriate.
Results: Of the 782 event reports reviewed, 59 (9%) were directly related to physician-physician communication during consultations and were categorized into six main groups: 1) inadequate verbal communication between providers (73%); 2) inadequate verbal communication between the provider(s) and the patient and/or their family (10%); 3) inadequate chart documentation from providers (10%); 4) delays in communication (3%); 5) inappropriate communication (2%); and 6) not accepting a consult (2%). Inadequate verbal communication was further categorized by environment: ED (23%), inpatient (47%), and inpatient involving an operation/procedure (30%).
Interviews of 33 inpatients with GS consults and 17 with MO consults were conducted between June and August 2018. Five major patient-perceived issues with provider communication were identified with sub-themes detailed in Table 1: 1) inadequate verbal communication between provider(s) and the patient/family; 2) poor communication between physicians; 3) communication with the patient before consensus on a plan has been reached; 4) use of excessive medical terminology; and 5) inadequate non-verbal communication. Only patients with GS consults reported use of excessive medical terminology.
Conclusion: Inadequate verbal communication between providers is frequently identified as problematic in the inpatient setting by both clinicians and patients. The periprocedural setting represents a significant portion of these verbal communication issues. In order to improve communication within the hospital consultation process, strategies that target the quality of provider-to-provider and provider-to-patient communication, particularly in the peri-procedural setting, are likely to be most productive.
