Improving Clinical
Communication with Healthcare Technology
Problem
Research has proven that a breakdown in communication between
clinical staff leads to increased patient harm and length of stay. Joint Commission
reports have revealed that communication failures were the main cause of
sentinel events. While investigating contributing factors to clinical errors,
nursing staff attributed communication issues with physicians as one of the top
contributing factors. Research is growing strong on the correlation between patient
safety and error prevention and ineffective communication among clinical staff.
Identification of why these failures continue to occur even with the implementation
of electronic medical records is imperative. There have been several multidisciplinary
studies completed encompassing this problem and their conclusions ended with
the evaluation and implementation of improved communication tools, escalation
processes, patient centered rounds and team huddles tailored to correct the
faults within their specific organization.
It was no surprise that similar breakdowns in communication have
occurred within my current facility. Over the past few years, I have noticed my
health care organization stepping forward and taking action to begin developing
a plan that is due to launch in the near future. It involves the complete restructuring
of management and clinical staff as well as the implementation of several
additional processes to ensure that communication is increased across the board
and patient safety remains a top priority. Not only does it include increasing staff
presence on the floor across multiple disciplines, integration of more current
technologies are also included in order to create one cohesive team that is
centered around the patient with one common goal: to aid in the prevention of
medical errors while aiding in the patients recovery to a safe discharge. The
way we currently provide care to patients hasn’t been altered in decades and research
has shown that the way we currently provide care is fragmented. How we provided
care sixty years ago is no longer effective and the only way to fully correct
the problem is to completely over-haul our healthcare system to match the needs
of our current societal demands.
“Improving Patient Safety through Provider Communication
Strategy Enhancements” by (Dingley et. al, 2008) describes a number of
challenges health care professionals face with effective communication. The
article reviews several interrelated dynamics with associated attributions. It
reviews how healthcare is complex and unpredictable with a “variety of disciplines
involved in providing care at various times throughout the day, often dispersed
over several locations, creating spatial gaps with limited opportunities for
regular synchronous interactions”. The author goes on to state that all
providers view and prioritize patient needs differently as well as each person
having “different levels of education and training backgrounds frequently leading
to an hierarchical organizational structure that leads to a culture of
inhibition and restrain in communication rather than a sense of open, safe
communication”. For this type of environment to stop, complete restructuring of
staff and how we provide patient-centered care should be restructured in its
entirety with further integration of new technologies to allow for more cohesive
and structured care.
Proposed
Solution
The purpose of this restructure is to change everything we
know about providing patient centered care. Breaking the barrier of a hierarchical
environment is the first step in creating a successful communication. This
model would mirror a critical care setting in which there would be one physician
over all the patients as opposed to having multiple physicians floating around each
unit. The physicians would be assigned to their home unit and work 7 days on
and have 7 days off in order to maintain a continuation of care for the
patients as well as the staff on the floor. Two physicians would be assigned to
work opposite schedules on the same unit for a period of three to four months
at a time at which point the physicians would rotate to different specialties. This
would eliminate the confusion that comes with multiple physicians on a floor
providing care. In addition to this, a pharmacist, dietician, nurse educator,
case manager and the nurse manager/director would create a cohesive team for
which the nurse can work closely with. Once the team is assembled, daily bedside
rounding with the patient and every member of the team present would be
required to review patient status and plan of care. This would eliminate any
confusion when it comes to patient care and the expectations of the patient
from the team.
According to the American Association of Critical-Care Nurses,
“Patient flow and acuity are dynamic, so staffing has to be dynamic as well”. From
the nursing perspective, nurse to patient ratios should be reviewed. Currently,
my floor is at a 4:1 nurse to patient ratio which is in alignment with current
national recommendations. We have 25 beds on one unit and have 1-2 patient care
techs scheduled. Increasing the number of patient care technicians on the floor
would decrease patient wait time and increase patient safety and satisfaction.
The goal would be to base the nurse’s assignment off of acuity of the patients
maxing out with a 5:1 nurse to patient ratio for progressive care units. However,
with this increase comes help. Patient care technicians (PCTs) would be
assigned to a specific nurse for the duration of the shift to work only with
that nurse and those patients. This would lead the patient care tech to have a
5:1 patient to nurse/PCT ratio. This means increased PCTs on the floor and
decreased patient ratios so that more individualized care and attention can be
provided to the patient. With less patients to be stretched between, PCTs can
now be educated on providing a wider variety of care.
Furthermore, integration of current and new technologies
must be taken into consideration. Healthcare is moving towards generating one
cohesive system in regards to patient care. Healthcare facilities are solely
responsible for providing up to date equipment for their staff that allows for interoperability
to take place. Currently, we have made great strides with integrating
electronic medical records from within individual health care organizations.
However, we need to continue to push for further advancement. Smart watches,
phones and other personal devices already help patients keep track of particular
healthcare information. Nursing informatics is a rapidly growing industry and
it is going to help shape the way we can provide care to our patients. As an
advanced practice nurse, the more integration there is the better. As we continue
to develop personal devices that have the ability to communicate with health
care providers at any point in time, we will start to see one cohesive patient
chart come together that is more detailed than ever. Imagine being unconscious and
being brought to the emergency room. You are unresponsive. As we progress and
integrate these smart devices, I will eventually be able to obtain your entire
medical record by simply gaining access to your smart device. This would ultimately
provide increased patient safety, decreased sentinel events and more through
care.
Recommendations
for Improvement
Connectivity with physicians and advanced practice nurses
through the internet has rapidly integrated into our society. Pushing the boundaries
of technology is limitless. Facilities are moving towards equipment that communicates
with electronic medical records eliminating the need for human error when it
comes to charting. Although this technology is still in its infancy, facilities
are making the move towards more and more integration and less human involvement.
Double charting and medication errors will soon be a thing of the past. As a future
nurse practitioner, I look forward to being able to provide my patients with equipment
that would allow them to communicate with me more often as well as allow me to
review their status and prevent any negative occurrences from happening
prematurely.
Being able to remotely diagnose and treat patients in vital to the modern world. As technology advances, telehealth becomes more integrated into our society. Within healthcare, it is becoming increasingly prevalent to receive care indirectly. Restructuring inpatient care as well as restructuring the way we provide care to those on an outpatient basis will completely change the way healthcare is provided in the future for the better. Implementing these frameworks would enable the medical field to become more intelligent in an overall aspect as well as providing the ability to face a changing environment making way for innovation and improved clinical performance.
Conclusion
Improving communication within healthcare is multi-faceted and
ever-changing. It is the responsibility of healthcare organizations to step
back and re-evaluate the way healthcare is provided. Changing the environment,
providing more education to staff and integrating new technologies on an
inpatient and outpatient basis are all recommendations for future progression.
If we continue healthcare how it is today, we will never see improvement.
Integration of new technology and implementing different strategies as a whole
will push the boundaries of healthcare. Increasing patient centered care and by
altering staff related complications in addition to welcoming technological
advancements is the future. As an advanced practice nurse, I am excited to see
what the future holds and what I can contribute to push its advancement in the
right direction.
References
Dingley C, Daugherty K, Derieg MK, et al. Improving
Patient Safety Through Provider Communication
Strategy Enhancements. In: Henriksen K, Battles JB, Keyes MA, et al., editors. Advances in Patient Safety: New
Directions and Alternative Approaches (Vol. 3: Performance
and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug. Available from: https://www.ncbi.nlm.nih.gov/books/NBK43663/
I find your perspective interesting. Continuity of care is regularly an issue with maintaining interdisciplinary communication as well with the patient. Having the experience of a family member being admitting, one of the biggest expressed frustration is never knowing who anyone is and how they are important to care. Changing the way units are staffed and how physician rotations are handled is a conceivably viable option. I would be interested to see the research on this philosophy change.
ReplyDeleteI recently read an article discussing the use of the health portal as a means to keep the patient interactive in their care during the admission. The portal was a direct connection to the medical staff and allowed the patient to send questions when they had them- instead of trying to remember the next time someone came. Discharge planning was even tracked through the patients health portal. Even dietary selections were made though the use of tablet devises. As technology advances, health care needs to morph with the changes. Communication is key to maintaining patient safety but also keeping the patient informed on care plans.