Communication is Key

Rahul K. Shah, MD George Washington University School of Medicine, and Children’s National Medical Center, Washington, DC It has been more than a decade since the Institute of Medicine’s sentinel report on errors in healthcare, which outlined ways to systematically improve the quality of care in our country. There have been tremendous technological improvements during the past decade. For example, there is now broad reporting and acceptance of macro-level data, which allows trends to become apparent that can affect outcomes for our patients. Certainly, technology can be credited for helping to move the patient safety and quality improvement agenda forward in a dramatic fashion during the past decade. However, there is one issue that persists and at times eludes the healthcare profession: enhancing communication. We function in an antiquated communication paradigm where we see a patient in the office, dictate a letter, and then mail the letter to our referring physician. Usually by the time the physician receives our letter, we have operated on the patient and they are seeing us for post-operative visits. I am sure you can think of many similar examples. Other industries have similar communication issues, but have been able to embrace technology and use it to greatly enhance communication and service (think of Wall Street two decades ago versus now vis-à-vis trading equities). Of course, the electronic medical record is a giant leap forward in documentation and record keeping internally for practices and healthcare systems. However, at my last count there were hundreds of electronic medical record (EMR) companies out there—even one with free EMR. The problem with EMRs, however, is with inter-practice communication and within in a healthcare system. There is no doubt that we can and should track patient records; however, the EMRs do not address the communication void. It has been noted that more than a quarter of adverse events and medical errors involve communication breakdowns. This is not too hard to fathom because for a medical error to occur there are usually multiple breakdowns in the system that allow an issue to persist and manifest as an error. I often wonder with enhanced, rapid, or real-time communication if medical errors would be markedly reduced. The data seem to indicate so. There are certainly emerging platforms that exist to help change the manner in which we communicate in healthcare. I would posit that at present we can adopt low-technology solutions while awaiting broad acceptance of technologically more sophisticated alternative communication modalities. Simply, we can all attempt to over-communicate. I cannot fathom an instance where over-communication would be detrimental to patient care. Indeed, the military and other industries use refined communication tools, such as the Situation, Background, Assessment, Recommendation (S-B-A-R) technique to ensure proper communication. How about the drive through at fast food establishments? They often invoke the read back and verify rule with your order. They want to ensure your order is correct. Perhaps in healthcare we can do similarly to ensure the medication we dispense or order we give is correct. One of the constraints we have faced is the burden of regulations. HIPAA does place limits on how we can communicate, especially with electronic protected health information (e-PHI), which has come under tremendous scrutiny. Certainly there are technologies that are being developed for substantial cost, and some for free, that will improve healthcare communication. I implore Academy members to contemplate low-technology solutions for communication and seek platforms that are designed to enhance technology communication. The end goal being a reduction of adverse events and medical errors by improving the manner in which we communicate healthcare information. We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.