Errors in communication are widely recognized as an important cause of adverse events in health care. In 2010, communication problems were the most commonly cited root cause of sentinel events, according to data reported to the Joint Commission. 1
In fact, communication issues were identified as a root cause of two thirds of all the sentinel events reported to the Joint Commission since 1995. 2 According to data from the Institute of Medicine and the National Center for Health Statistics, if medical errors were listed among the causes of death in the United States, they would rank fifth—with an incidence higher than accidents, diabetes, Alzheimer’s disease, AIDS, breast cancer, and gunshot wounds.3,4
The Joint Commission recognizes a host of potential negative consequences of ineffective communication, including failure to document critical information, increased length of stay, increased costs, and negative patient perceptions of the health care experience. 5
Researchers and quality improvement organizations, such as the Institute for Healthcare Improvement and the Agency for Healthcare Research and Quality, have identified a number of interventions that can improve communication among health care providers, including teamwork training and the use of structured communication tools, such as SBAR (Situation-Background-Assessment-Recommendation). 5-9
A great deal of attention has been focused on improving patient safety, the quality of care, and clinical integration with the use of these interventions.
Until recently, relatively little attention has been paid to the prevalence and potential consequences of poor communication between physicians. However, a study published in Archives of Internal Medicine in January 2011 found that primary care providers who recounted a lack of timely communication from specialists regarding referrals were more likely to report that their ability to provide high-quality care was threatened. 10
Located outside of Chicago, Good Shepherd Hospital is a 186-bed facility with more than 700 physicians. It is one of 10 acute-care hospitals of Advocate Health Care, an integrated health system based in Oak Brook, Illinois.
Barry Rosen, MD, a general surgeon and vice president of Medical Management at Good Shepherd, had been concerned for several years about the scarcity of direct communication between requesting and consulting physicians. “
I first thought—incorrectly—that the lack of communication was due to laziness. Now I think it’s because we’re moving so quickly. It would be ludicrous to think that a busy physician rounding at the hospital is going to call a consultant directly if they believe the likelihood of reaching the specialist is low. The problem is that without the direct information, trying to decipher the reason for the consult can be like solving a crossword puzzle.”
As a physician leader, Rosen attempted to improve physician communication regarding consultation by instituting a hospital-wide policy that a physician—not the ward clerk or the unit nurse—had to call in the consult request. His attempts were not successful. “Physicians felt too rushed to take the time to call. It just didn’t happen.”
Rosen began searching for a tool that would foster direct communication between physicians, especially between those requesting a consult and the specialists consulted. After interviewing a number of companies with communication tools, in June 2010 Rosen approached PerfectServe.
The physician leader became convinced that the service was an ideal fit for the hospital and petitioned administrators to dedicate the funding necessary for signing on. “Physicians recognize the problem, but in the absence of a streamlined way to make the call, they’re just not going to do it. This tool offers a streamlined way to communicate.”
The PerfectServe system uses workflows and contact preferences from physician-specific algorithms to route calls and messages according to each physician, based on factors such as the day, time, urgency, clinical situation, preferred contact method, and coverage schedule. It includes an integrated module that optimizes communication between physicians and hospital staff, and another that can replace physicians’ traditional answering services and voice messaging systems.
Good Shepherd launched PerfectServe in October, 2010.
Using two clicks on his smart phone (or by dialing his PerfectServe account number from any phone), Rosen now can directly contact any physician on the medical staff, with the call routed based on that physician’s preference algorithm. “When I am showing the tool to other physicians, I call one of the physicians on staff who has set up their algorithm to route colleague calls directly to their cell phone. When physicians see how quickly it works, they’re very impressed.”
Obstetrician-Gynecologist Thomas Meyer, MD, has found that the service facilitates communication with other physicians. “It’s easier now to get in touch with another physician to talk about a consult.”
He recalls a recent case in which he and another specialist were consulted by a primary care physician. The primary care physician routed all of his calls directly through PerfectServe, whereas the specialist still relied on traditional channels. “My call went directly through to the primary care physician. But we had to wait to speak with the other consultant, going through his office, waiting for the answering service to reach him, and waiting for him to call back. It definitely caused a delay in trying to coordinate care.” It is delays like these that Dr. Rosen believes hamper clinical communications.
PerfectServe has also streamlined communication with ED physicians—an essential step in improving throughput in the department. Clerks in the department typically place calls for ED physicians who need to speak with consultants or primary care physicians.
With PerfectServe , the clerk now reaches a physician directly, rather than leaving a message with the physician’s staff or answering service and waiting for a call back.
According to Rosen, access is noticeably faster. “What sometimes took 20 minutes is now taking less than a minute. The clerk’s first response when she calls is often, ‘That was fast.’” In time, Rosen hopes that the ED physicians will place the calls themselves, further streamlining the process.
According to JoAnne Rosson, an ED clerk on the day shift, getting in touch with physicians is simpler and there is a shorter delay in hearing back from attending physicians regarding possible admissions. “I dial one number and say the physician’s name. It’s easier to use than the old system and easier to train new staff.”
Because staff no longer needs to rely on memory or notes on the computer contact list about revised coverage schedules, they are less likely to make time-consuming mistakes—like contacting a physician who is not on call.
Meyer finds communication with the ED to be more streamlined now. “The advantage is that we are directly linked with the ED. In the past, the ED physician would ask the clerk to call me. The clerk would call my answering service, which would contact me. By the time I called back, the ED doctor was with another patient and wasn’t available. When this happened in the middle of the night, it would be irritating. With a direct link, there’s less hassle and less delay.”
General Surgeon Daniel B. Wool, MD appreciates the fact that the new system has the capability to contact him quickly—and can indicate when the case involves major trauma. “Before, the answering service would sometimes forget to indicate in their text or message that the call was about a trauma case. Now, we know right away. And we don’t have the extra delay of the ED calling the answering service and the answering service then calling us. Since we only have 30 minutes to get to the hospital in response to a major trauma call, time is critical.”
As a practicing physician, Rosen also appreciates the fact that he receives fewer nonurgent calls. “Because patients now have an option to leave nonurgent messages for the next day, I receive about one third fewer calls to my phone. That’s a pretty significant improvement when you tend to be inundated with calls.”
Rosen also has found that the system can easily handle complex preference algorithms. “We have four physicians in our practice, and each one handles calls differently. If I wanted to be called at my home number from midnight to 3:00 a.m. every other Thursday, the system can do that for me.”
Wool also has a relatively complicated algorithm for his calls. When his office is open, calls from the ED or hospital are routed to his office phone. His staff then triages the call and sends him a text message. When the office is closed, PerfectServe triggers a text message—except between 10 p.m. and 7:00 a.m. when calls are routed to his cell phone. At 9:00 a.m. when his office opens, calls are again sent to his office staff. Wool appreciates the fact that the physician-specific algorithm allows him to control exactly how he is contacted throughout the day and night.
Good Shepherd is at a relatively early stage in the deployment of PerfectServe throughout their organization. “Right now we’re at step 1 out of 10 in getting physicians to use the system to its full advantage,” says Rosen.
According to data from the PerfectServe system, two-thirds of the medical staff are using the system as designed and realizing its benefits. The remaining one-third is using traditional channels of communication.
“There is no question that physicians who use the system to its full potential see an incredible difference in streamlined communication,” says Rosen.
PerfectServe continues to work with Dr. Rosen and the Good Shepherd medical staff to increase direct physician-to-physician contact. For example, physicians have agreed to distinguish colleague calls from others, and route those calls directly to their cell phones.
Health care organizations are increasingly focused on improving patient safety and clinical integration. Effective communication between physicians is essential for achieving these goals. Barry Rosen, MD of Good Shepherd Hospital has found PerfectServe is be an effective tool for streamlining communication between physicians—helping him to meet his ultimate goal of fostering improved patient care.
References
1. Joint Commission on Accreditation of Healthcare Organizations. The Sentinel Event Data Root Causes by Event Type2004-Fourth Quarter 2010. Available at: http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-4Q2010.pdf. Accessed February 22, 2011.
2. Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission's Sentinel Event Policy: ten years of improving the quality and safety of health care. Jt Comm Perspect. 2005 May;25(5):1, 3-5.
3. Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system . Washington, DC: National Academy Press, Institute of Medicine; 1999.
4. Centers for Disease Control and Prevention. National Center for Health Statistics. Deaths: final data for 1997. Natl Vital Stat Rep. 1999;47(19):5, 97, 99.
5. Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission guide to improving staff communication. Oakbrook Terrace, IL: Joint Commission Resources; 2009.
6. Mann S, Marcus R, Sachs B. Lessons from the cockpit: How team training can reduce errors on L&D. Contemp Ob Gyn. Jan 2006:1-7.
7. Botwinick L, Bisognano M, Haraden C. Leadership Guide to Patient Safety. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2006.
8. O’Daniel M, Rosenstein, AH. Professional communication and team collaboration. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality. 2010. Available at: http://www.ahrq.gov/qual/nurseshdbk/docs/O%27DanielM_TWC.pdf. Accessed February 22, 2011.
9. Institute for Healthcare Improvement. SBAR technique for communication: a situational briefing model. Available at: www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Tools/SBAR
TechniqueforCommunicationASituationalBriefingModel.htm. Accessed February 22, 2011.
10. O’Malley AS, Reschovsky JD. Referral and consultation communication between primary care and specialist physicians: finding common ground. Arch Intern Med. 2011;171(1):56-65.