Defining Communication Improvement Needs in General Surgery: An Analysis of Pages, Communications, Patterns, and Content☆?>

Discussion-based interprofessional education: A positive step toward promoting shared understanding between surgical residents and nurses

Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2-6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive.

To page or not to page? A qualitative study of communication practices of general surgery residents and nurses

BACKGROUND

Communication errors contribute to preventable adverse hospital events; however, communication between general surgery residents and nurses remains insufficiently studied. The purpose of our study was to use qualitative methods to characterize communication practices of surgical residents and nurses on inpatient general and intermediate care units to inform best practices and future interprofessional interventions.

METHODS

Our study cohort consisted of 14 general surgery residents and 13 inpatient nurses from a tertiary academic medical center. Focus groups were conducted via a secure video platform, recorded, and transcribed. Two authors performed open coding of transcripts for qualitative analysis. Codes were reviewed iteratively with themes generated via abductive analysis, contextualizing results within 3 domains of an established communication space framework: organizational, cognitive, and social complexity.

RESULTS

Communication practices of general surgery residents and inpatient nurses are affected by workflow differences, disruptive communication patterns, and communication technology. Barriers to effective communication, as well as strategies used to mitigate challenges, were characterized, with select communication practices found to negatively affect the well-being of patients, nurses, and residents.

CONCLUSION

Communication practices of general surgery residents and inpatient nurses are influenced by entrenched and interrelated organizational, technological, and interpersonal factors. Given that current communication practices negatively affect patient and provider well-being, collaboration between surgeons, nurses, systems engineers, health information technology experts, and other stakeholders is critical to (1) establish communication best practices, and (2) design interventions to assess and improve multiple areas (rather than isolated domains) of surgical interprofessional communication.

Nighttime Calls, Pages, and Interruptions to the On-Call Surgery Resident

BACKGROUND

Communication is a keystone to good medical practice. At night, as physician numbers decrease, frequent, nonurgent interruptions have shown to disrupt patient care and impact resident/physician wellness. Potentially, interruptions can lead to an increase in medical errors. The frequency and activities interrupted during night calls have not been fully described.

METHODS

For a period of 44 days (August through September), all calls and pages received during the 12-hour night call session were documented. Calls were analyzed by caller, urgency, need for intervention, and resident interrupted by the communication.

RESULTS

A total of 494 communications were identified with a mean of 10 calls per shift (IQR 7-14). Communications lasted a mean of 2.7 +/- 2.9 minutes. Direct calls occurred in 78% and pages in 22% of the cases. From the non-ED calls (n = 335), most of them came from nursing staff (85%), followed by other specialties (12%). Five percent of the calls were directed to the wrong service. Communications occurred during charting (41%), patient assessment (33%), interrupted resident's sleep (12%), or during a surgical procedure (6%). Communication required no action in 47% of the cases. A physician order was needed in 41%, while bedside clinical assessment was required in 12% of the calls.

CONCLUSIONS

Communications are common at night, but most did not require clinical assessment. A large portion of communications interrupted direct patient care. An opportunity exists to eliminate nonproductive communications and improve the quality of medical education.

A quality improvement project to improve pediatric medical provider sleep and communication during night shifts

QUALITY PROBLEM OR ISSUE

Night-shift medical providers frequently experience limited sleep resulting in fatigue, often because of paging activity. Streamlined medical-specific communication interventions are known to improve sleep and communication among these providers.

INITIAL ASSESSMENT

We found that non-urgent paging communication occurred frequently during night-shifts, leading to provider sleep disturbances within our institution. We tested a quality improvement (QI) intervention to improve paging practices and determined its effect on provider sleep.

CHOICE OF SOLUTION

We used a Plan-Do-Study-Act QI model aimed at improving clinician sleep and paging communications.

IMPLEMENTATION

We initially conducted focus groups of nurses and physician trainees to inform the creation of a standardized paging intervention. We collected actigraphy and sleep log data from physicians, nurse practitioners, and physician trainees and performed electronic collection of paging frequency data.

EVALUATION

Data were collected between December 2015 and March 2017 from pediatric residents, pediatric hematology/oncology (PHO) fellows, hospitalist medicine nocturnists and nurses working during night-shift hours in PHO inpatient units. We collected baseline data before implementation of the QI intervention and at 1 month post-implementation. Although objective measures and provider reports demonstrated improved medical-specific communication paging practices, provider sleep was not affected.

LESSONS LEARNED

Provider-based standardization of paging communication was associated with improved medical-specific communication between nurses and providers; however, provider sleep was not affected. The strategies used in this intervention may be transferable to other clinics and institutions to streamline medical-specific communication.