Content provided in partnership with

Health Care Industry

Improving verbal communication in clinical care

AORN Journal, May, 2004 by Suzanne C. Beyea

Most health care organizations have developed guidelines or policies and procedures to address certain forms of written communication, such as which parts of the clinical record or forms should be completed during an episode of care. Typically, admission assessment forms specify which data should be collected and recorded when a patient is admitted to a health care facility. Certain forms are completed before ambulatory surgery, whereas others are completed before inpatient surgery. Most clinical records consist of specifically designed forms that help ensure the type and consistency of information about a patient's care.

More Articles of Interest: Making Primary Care Culturally Competent; Do COX-2 inhibitors increase congestive heart failure?; Pain management; Advance directives; guarding your patient against ARDS

Structured clinical documents and written procedures do not always ensure the completeness or accuracy of clinical forms or records. Clinicians encounter situations in which a patient cannot answer questions or provide accurate information. Occasionally, clinicians may record information in an illegible manner or fail to complete a form. Despite this, the clinical record provides the most consistent source for patient-specific health care data. The patient's record serves as the source from which numerous clinicians can access pertinent information about a patient's diagnosis, allergies, laboratory results, history, physical examination findings, and other data. Most clinicians expect a patient's chart to contain reliable and valid information and understand that it serves as the legal record of the patient's care.

VERBAL COMMUNICATION PROBLEMS

Verbal communication between clinicians generally is much less structured and consistent than written communication. In health care facilities, verbal communication is a primary way in which vital information about a patient's status and care is transmitted. Nurses and physicians give each other verbal reports with few guidelines to ensure completeness and accuracy, however. When information is transferred verbally, valuable data can be lost or misinterpreted. Problems with verbal communication in health care emerge in part from the fact that clinicians receive little education on how to communicate effectively with each other.

Other factors contributing to problems with verbal communication include a lack of structured policies and procedures about its content, timing, or defined purposes. Furthermore, most clinicians lack a shared mental model or framework for verbal health care communication. Rules exist for written documentation, but none exist for the frequent verbal transmissions of information that occur face-to-face or on the telephone.

Most health care professionals receive education that focuses on communicating with patients. These same programs otter little or no education about communicating with other clinicians or how to communicate effectively in urgent or emergent situations. Most recent graduate nurses have limited experience calling a physician on the telephone to give a status report or giving report when transferring a patient to another unit.

Each nurse also has specific ideas or beliefs about what information should be communicated during a verbal report. Valuable information may not be provided or may be forgotten. Writing information down may help a clinician recall data later, but if there is no consistent format for recording the information, it may be lost regardless. Interruptions, distractions, and the frequency of communications also may negatively affect the communication process and contribute to a clinician forgetting to share pertinent information.

The rate of communication in an OR adds to the complexity of keeping track of information in an accurate manner. A recently published study examined communication patterns in four OR suites. From 17 nonconsecutive days of observations in four-hour to six-hour blocks, researchers found that charge nurses experienced 32 to 74 communication episodes per hour. Within an hour, charge nurses communicated with at least five members of the health care team. The modes of communication included face-to-face, telephone, and intercom and lasted a mean of 40 seconds each. (1)

COMMUNICATION STYLES

Communication problems have been associated with medical errors and adverse events in a number of studies. (2,3) Errors related to communication problems may result from the lack of guidelines for clinician-to-clinician communication and the lack of a shared framework and approach to communication. A number of experts have begun to explore and identify approaches to improve clinician-to-clinician communication. Their goal is to enhance patient safety by preventing the loss of crucial clinical data and promoting sharing of pertinent information at the right time in the most effective manner.

Michael Leonard, MD, director of patient safety for the Colorado Permanente Medical Group, Denver, and physician director of patient safety for Kaiser Permanente, Oakland, Calif, describes distinct differences between nurse and physician communication. He characterizes nurses' communications as narrative and descriptive, whereas physicians' communications are more focused on an exact problem or need. Dr Leonard suggests using the situational briefing model or SBAR (ie, situation, background, assessment, recommendation) model as one approach to addressing these differences in communication style and approach. The SBAR model provides a consistent and shared framework for nurse/physician communication. (4) This model proposes that a nurse communicating with a physician should provide

Health Care Industry

Improving verbal communication in clinical care

AORN Journal, May, 2004 by Suzanne C. Beyea

Find Research Guides for:

Find Featured Titles for: Reference

Most Popular Articles in Health

Most Popular Publications in Health