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Communication Tips for Improved Patient Safety

By Doug Bennett, contributor

It is estimated that more than 400,000 people die each year due to preventable medical errors, according to a 2013 study published in the Journal of Patient Safety. When medical errors are included in rankings of the top 10 causes of death in the United States, they rank third--behind only heart disease and cancer. Additionally, the rate of serious, nonlethal harm from errors is estimated to be 10 to 20 times higher than the rate of lethal errors.

Communication failure at the root of many medical errors

Communication failure can be at the root of many medical errors

Studies show that 93 percent of communication occurs through body language and tone, with only 7 percent of meaning and intent derived from the actual words spoken. This can lead to assumptions that information--sometimes life-saving--has been successfully conveyed to others in the care team or between healthcare workers and patients when, in fact, it has been misunderstood.

Almost half of all Americans have difficulty understanding and using health-related information.¹  Patients can struggle with the physical and emotional strain of their condition(s), as well as the chaotic and emotionally charged atmosphere in a hospital or clinic. Many patients--often medicated, weak, and confused--may be seen by dozens of staff in a day, setting the stage for communication breakdowns. Language barriers and a wide literacy gap between the average healthcare worker and patient are other contributing factors.

The focus on error-free practice can also cause intense peer pressure. When errors are perceived as an expression of failure, it fosters an atmosphere that can preclude the fair and open discussion of mistakes, which is necessary for learning and improvement to occur.

A culture to support communication and collaboration

The challenge for healthcare organizations is establishing a culture of open, non-retaliatory communication. Creating and reinforcing a safety-focused culture must be regarded as essential by management because overall buy-in and consistency across the organization are necessary for effective implementation of any attempted solutions.

At the national level, the Center for Patient Safety (CPS) joins the National Patient Safety Foundation’s campaign to raise awareness about patient safety best practices. This year Patient Safety Awareness Week is March 13-19. Download a helpful toolkit containing resources and tips to raise awareness about how good communication practices can enhance patient safety and outcomes in your organization.

Helpful tools to enhance communication

Checklists are effective tools for reducing the risk of slips, which can occur when fatigue or workplace distractions impact tasks normally performed on “autopilot.” The Agency for Healthcare Research & Quality (AHRQ) provides helpful guidance about what constitutes a good checklist on their web site.

Structured briefings are another technique to help set expectations between team members and provide a standardized, easy-to-remember mechanism for framing communications, especially when accuracy is vital. One successful example is the widely used Situation-Background-Assessment-Recommendation (SBAR) tool, first adapted in the healthcare industry by Kaiser Permanente.

Closing the loop with patients is a tried and true strategy commonly used by nurses and allied health professionals. The “teach back” method involves asking the patient to recall and repeat or explain the information just conveyed. Based on the patient’s response, allied professionals can determine how well the patient understood. If necessary, the information or instructions can be repeated or clarified. Using white boards in patient rooms to reinforce communications with patients and family is another effective method.

Intentional rounding, or conducting regular checks with patients at set intervals, helps staff work together to achieve clear, measurable goals with each round. Consistency of care builds confidence and trust between patients and staff, and reduces medical errors while also easing anxiety for patients. Research shows significant improvements in call buzzer use, patient falls, pressure ulcers, and overall patient satisfaction after the introduction of intentional rounding.²

Considerable progress is being made with increased use of electronic health records (EHRs), which can help avoid or mitigate communication problems stemming from language barriers and literacy gaps. Some states, like New York, now require use of electronic prescriptions to reduce fraud and errors that can occur with more traditional prescribing methods.

One of the most comprehensive resources for protocols aimed at helping improve patient safety is the AHRQ Health Literacy Universal Precautions Toolkit. The AHRQ also provides a helpful summary of the key communication protocols in the healthcare environment.

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¹Institute of Medicine of the National Academies, 2004
²Alliance for Health Care Research

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