Communication in healthcare: a narrative review of the literature and practical recommendations

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Summary

Objectives

Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare.

Design

Narrative literature review.

Methods

A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (Me SH)terms ‘communication’, ‘primary health care’, ‘correspondence’, ‘patient safety’, ‘patient handoff’ and ‘continuity of patient care’. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorisation as original research, reviews, meta‐analyses or letters to the editor.

Results

A total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences.

Conclusion

There is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow‐up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver.

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Most cited references 57

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Communication failures: an insidious contributor to medical mishaps.

Kathleen M. Sutcliffe, Elizabeth Lewton, Marilynn Rosenthal (2004)

To describe how communication failures contribute to many medical mishaps. In late 1999, a sample of 26 residents stratified by medical specialty, year of residency, and gender was randomly selected from a population of 85 residents at a 600-bed U.S. teaching hospital. The study design involved semistructured face-to-face interviews with the residents about their routine work environments and activities, the medical mishaps in which they recently had been involved, and a description of both the individual and organizational contributory factors. The themes reported here emerged from inductive analyses of the data. Residents reported a total of 70 mishap incidents. Aspects of "communication" and "patient management" were the two most commonly cited contributing factors. Residents described themselves as embedded in a complex network of relationships, playing a pivotal role in patient management vis-à-vis other medical staff and health care providers from within the hospital and from the community. Recurring patterns of communication difficulties occur within these relationships and appear to be associated with the occurrence of medical mishaps. The occurrence of everyday medical mishaps in this study is associated with faulty communication; but, poor communication is not simply the result of poor transmission or exchange of information. Communication failures are far more complex and relate to hierarchical differences, concerns with upward influence, conflicting roles and role ambiguity, and interpersonal power and conflict. A clearer understanding of these dynamics highlights possibilities for appropriate interventions in medical education and in health care organizations aimed at improving patient safety.

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Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs.

Darrell J Solet, J Michael Norvell, Gale H Rutan … (2005)

Handoffs involve the transfer of rights, duties, and obligations from one person or team to another. In many high-precision, high-risk contexts such as a relay race or handling air traffic, handoff skills are practiced repetitively to optimize precision and anticipate errors. In medicine, wide variation exists in handoffs of hospitalized patients from one physician or team to another. Effective information transfer requires a solid foundation in communication skills. While these skills have received much attention in the medical literature, scholarship has focused on physician-to-patient, not physician-to-physician, communication. Little formal attention or education is available to reinforce this vital link in the continuity of patient care. The authors reviewed the literature on patient handoffs and evaluated the patient handoff process at Indiana University School of Medicine's internal medicine residency. House officers there rotate through four hospitals with three different computer systems. Two of the hospitals employ a computer-assisted patient handoff system; the other two utilize the standard pen-to-paper method. Considerable variation was observed in the quality and content of handoffs across these settings. Four major barriers to effective handoffs were identified: (1) the physical setting, (2) the social setting, (3) language barriers, and 4) communication barriers. The authors conclude that irrespective of local context, precise, unambiguous, face-to-face communication is the best way to ensure effective handoffs of hospitalized patients. They also maintain that the handoff process must be standardized and that students and residents must be taught the most effective, safe, satisfying, and efficient ways to perform handoffs.

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Effect of discharge summary availability during post-discharge visits on hospital readmission.

Andreas Laupacis, P. Austin, Carl van Colen … (2002)

To determine if the delivery of hospital discharge summaries to follow-up physicians decreases the risk of hospital readmission. Eight hundred eighty-eight patients discharged from a single hospital following treatment for an acute medical illness. Teaching hospital in a universal health-care system. We determined the date that each patient's discharge summary was printed and the physicians to whom it was sent. Summary receipt was confirmed by survey and phoning each physician's office. Each patient's hospital chart was reviewed to determine their acute and chronic medical conditions as well as their course in hospital. Using population-based administrative databases, all post-hospitalization visits were identified. For each of these visits, we determined whether the summary was available. Time to nonelective hospital readmission during 3 months following discharge. The discharge summary was available for only 568 of 4,639 outpatient visits (12.2%). Overall, 240 (27.0%) of patients were urgently readmitted to hospital. After adjusting for significant patient and hospitalization factors, we found a trend toward a decreased risk of readmission for patients who were seen in follow-up by a physician who had received a summary (relative risk 0.74, 95% confidence interval 0.50 to 1.11). The risk of rehospitalization may decrease when patients are assessed following discharge by physicians who have received the discharge summary. Further research is required to determine if better continuity of patient information improves patient outcomes.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Clin Pract

Journal ID (iso-abbrev): Int. J. Clin. Pract

Journal ID (doi): 10.1111/(ISSN)1742-1241

Journal ID (publisher-id): IJCP

Title: International Journal of Clinical Practice

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 1368-5031

ISSN (Electronic): 1742-1241

Publication date (Electronic): 06 July 2015

Publication date (Print): November 2015

Volume: 69

Issue: 11 ( doiID: 10.1111/ijcp.2015.69.issue-11 )

Pages: 1257-1267

Affiliations

[ ¹ ] Department of General Internal MedicineGhent University Hospital GhentBelgium

[ ² ] Department of Internal MedicineGhent University Hospital GhentBelgium

[ ³ ] Department of Public HealthGhent University Hospital GhentBelgium

[ ⁴ ] Department of Business EconomicsHasselt University DiepenbeekBelgium

[ ⁵ ] Faculty of Medicine and Health SciencesGhent University Hospital GhentBelgium

[ ⁶ ] Department of Emergency MedicineGhent University Hospital GhentBelgium

Author notes

[*] [* ] Correspondence to:

Peter Vermeir, Department of Internal Medicine, De Pintelaan 185, 9000 Gent, Belgium

Tel.: + 32 9 332 23 49

Fax: + 32 9 332 38 95

Email: peter.vermeir@ 123456uzgent.be

Article

Publisher ID: IJCP12686

DOI: 10.1111/ijcp.12686

PMC ID: 4758389

PubMed ID: 26147310

SO-VID: 1a354418-3e5f-4627-9a10-ecaa829c5189

License:

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date received : 12 February 2015

Date accepted : 29 May 2015

Page count

Pages: 11

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source-schema-version-number 2.0

component-id ijcp12686

cover-date November 2015

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:4.7.6 mode:remove_FC converted:18.02.2016

Communication in healthcare: a narrative review of the literature and practical recommendations

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Radiology and Natural Language Processing

Most cited references 57

Communication failures: an insidious contributor to medical mishaps.

Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs.

Effect of discharge summary availability during post-discharge visits on hospital readmission.

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