Miscommunication in Healthcare: Why it Happens and How to Stop It
Healthcare providers work as a team to keep people alive — and when there’s a breakdown in communication, errors can occur. Perhaps you’ve heard stories of miscommunication in healthcare that led to patient harm or even death. In this article, we discuss vulnerabilities in healthcare environments that increase the risk of harm and how to prevent them. We share how healthcare leaders can identify gaps in communication to improve patient outcomes.
Causes of Poor Communication in Healthcare
Clear and accurate communication among healthcare team members is essential for keeping patients safe. Miscommunication can occur at multiple points in the care delivery process, including the following interactions:
Providers and Patients
Physicians, nurses, and other providers must keep patients informed about changes in their plan of care, upcoming tests and procedures, medications, and more. They’re responsible for providing patient education that is clear and appropriate for their learning style. When patients aren’t included in clinical decisions, they’re less likely to be active participants in their care, which can cause dissatisfaction. As a result, poor communication between providers and patients is a leading reason for reduced patient satisfaction scores.
Members of the Multidisciplinary Team
Healthcare professionals such as advanced practice providers, nurses, respiratory therapists, social workers, dieticians, and pharmacists make up a multidisciplinary team. All team members must have clear lines of communication with one another when discussing the plan of care. Team collaboration allows individuals to clarify their roles and anticipate how the plan will be executed.
Managers and Staff
As the conduit between healthcare administration and the nursing staff, the manager is responsible for communicating practice changes that affect patient care. One of the many duties of a nurse manager is to check in with staff routinely through meetings, huddles, and at the bedside. They help identify gaps in communication between patients and providers by performing bedside rounds to address patient concerns.
The Impact of Miscommunication Among Healthcare Professionals
Effective communication, whether through technology or in-person, ensures healthcare providers have access to accurate patient information necessary to deliver effective care. This may include past medical history, medications, treatment plans, and interventions performed on a given shift. Delays in communication or misinterpretation can lead to medical errors that affect patient outcomes.
Failure to communicate drug knowledge and patient information is the most common systems error in healthcare. This type of miscommunication can lead to medication errors, which are the third leading cause of death in the U.S. Other examples of miscommunication in healthcare include:
Verbal Misunderstandings
Most healthcare facilities follow best practices for placing orders, which state that providers should avoid verbal orders. For situations that warrant verbal orders, CMS regulations require the ordering practitioner to promptly place the orders in writing with the time, date, and authentication.
Example: A nurse practitioner asks the bedside nurse to “turn the dopamine drip on at three.” The nurse interprets this as turning the drip on at three o’clock, instead of 3/mcg/kg/minute.
Written Errors
Successful implementation of computerized physician order entry (CPOE) significantly reduced medication errors in healthcare facilities. Electronic medication ordering reduces the risk of errors related to illegibility, inappropriate abbreviations, drug-drug interactions, and allergies. However, medication errors can occur in the practice setting without verification systems that utilize qualified professionals to check medication orders against the eMAR.
Example: A physician orders a narcotic containing acetaminophen, which is approved by the EHR system because it’s an appropriate dose and frequency. The pharmacist doesn’t approve the dose due to the patient’s risk of liver failure. The pharmacist clarifies that the provider meant to order the narcotic without acetaminophen.
Inaccurate Documentation
Healthcare facilities are busy, and if a provider can’t visit the bedside to check on a patient, they rely on charting to see if orders were completed. A major gap in communication can occur if a nurse or patient care attendant doesn’t document their interventions.
Example: A physician checks the chart of a postop patient with an increased oxygen requirement. The patient has orders to ambulate three times a day but hasn’t gotten out of bed, according to documentation. The physician calls the nurse, who says the patient has ambulated twice, it just wasn’t charted. This informs the decision to check other causes for their oxygen requirement.
How to Prevent Miscommunication in Healthcare
Effective communication requires commitment and effort from all stakeholders. By focusing on clear protocols, fostering a culture of open communication, and effectively utilizing technology, healthcare providers can improve patient outcomes. The following tips can help your healthcare facility improve communication.
1. Use Technology That Supports Information Flow
Electronic health records (EHR) systems help streamline information sharing across healthcare settings. This is especially important during transfers of care, where important pieces of information like medication records can be lost. Integrating the same EHR systems at all facilities within your organization allows information to follow a patient wherever they go.
2. Create a Culture of Closed-Loop Communication
During staff training, such as new hire orientation, include training on closed-loop communication. This helps create a culture that welcomes clarification, questions, and critical thinking. Hospitals can also encourage closed-loop communication during simulation training, such as ACLS or PALS. In these trainings, healthcare professionals are trained to ask questions like, “What is the indication?” for drug orders or other interventions during emergencies, where communication is interrupted.
3. Reduce Added Stress in the Working Environment
A chaotic work environment increases the likelihood of miscommunication in healthcare. When nurses are overwhelmed with a heavy workload, there is less time to effectively communicate with one other and the rest of the medical team. To prevent this, healthcare leaders must take steps to create a healthy work environment, including the prioritization of safe staffing ratios.
4. Move Patient Handoff to the Bedside
A Joint Commission study found that 80% of medical errors were the result of poor communication during patient handoff. To prevent miscommunication in healthcare, many facilities utilize bedside shift handoff between nurses. Nurses visit the patient’s room during handoff and review pertinent information together. One study found that implementing bedside reports reduced fall rates by 24%.
Another way to improve communication during a nursing shift report is to use a standardized report sheet. An SBAR (situation, background, assessment, recommendations) tool allows the offgoing nurse to streamline information and better communicate patient data to the oncoming nurse.
5. Have Regular Team Huddles
Each nursing unit should have processes to prioritize communication among the nursing and medical teams throughout the shift. This starts by having huddles in the beginning of the shift to discuss anticipated patient movement and events throughout the day. This also makes nursing staff aware of the sickest patients and anticipate potential emergencies.
Interdisciplinary rounds are another way to allow the healthcare providers involved in a patient’s care plan to collaborate and make a plan for the day. By bringing together each member of the team, professionals can discuss the plan and work through challenges together.
Foster Clear Communication and Stay Updated on Other Best Practices
We’ve provided statistics and examples highlighting the risk of medical errors due to miscommunication in healthcare and provided tips on how to improve communication at your facility. Find more ways to promote best-practice care at your organization in IntelyCare’s free newsletter.