The Effect of Nurse-Physician Communication on the Quality of Patient Care

Running head: the effect of nurse-physician communication1

the effect of nurse-physician communication10

The Effect of Nurse-Physician Communication on the Quality of Patient Care

Amanda Cooley, Ora Despain, Tessa Elder, Adam Hyatt, Spencer May, Libbey Steed

Dixie State University

Abstract

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The Effect of Nurse-Physician Communication on the Quality of Patient Care

The purpose of this paper is to conduct evidence based practice study as part of first semester nursing school project.

Practice Question

While trying to find better ways to care for patients and provide better outcomes, the topic of communication came up. Specifically, communication between nurses and doctors and how it affects patient care. Six Dixie State University nursing students each performed an article review in order to better understand this issue and make use of the findings in the clinical setting and throughout our education.

P- Patient Population or Problem

The problem were concerned with is ineffective communication between the nurse and admitting physician in acute care and how it relates to patient outcomes.

I- Intervention

Were interested in what interventions can be done to improve nurse-doctor communication (SBAR & other accepted communication methods).

C- Comparison

Were comparing and contrasting standardized and non-standardized communication.

O- Outcomes

Our speculative outcome would be to identify common problems in communication, what can be done to mitigate them, and what effect it has on patient outcomes.

The Following Question was Developed

In the acute care setting, does inconsistent communication between nurses and physicians affect the quality of patient care throughout the duration of the stay?

Evidence

This is a causation type of question and, as such, the online databases CINAHL, Cochrane, Medline, and Pubmed were searched for articles related to cohort, case control, descriptive, qualitative, and systematic review studies.

Search Items and Results of Search

The search terms garnered from the PICO question included: patient care, admitting physician, nurses, acute care, and communication. The search was limited to articles in English published from 2008 to the present. A search term excluded was long-term care. Based on the search terms and type of question, our group found six articles related to our question. Of those six, four were qualitative studies, one was a systematic review, and the other was a professional opinion.

Study One

The purpose of this study was to evaluate the effectiveness of SBAR collaborative communication for best practice. 215 staff and 30 physicians in a pediatric/perinatal unit on a 271 bed hospital in Arizona were involved in a convenience sample study. Data was collected through pre-intervention and post-intervention questionnaires and evaluated using Mann-Wittney U for statistical quantitative analysis. 212 staff participated in the intervention, 141 completed pre-intervention surveys and 71 completed post-intervention surveys. The quantitative analysis revealed that 18 out of 27 items from the questionnaires were significantly statistically different in the post intervention compared to the pre intervention. Qualitative analysis suggested SBAR-CCE improved physician-nurse communication and relations which in turn improved patient safety outcomes, although no specific safety outcomes were cited or measured. The recommendations for larger populations including hospital wide populations, longer length of study, and increased physician involvement were made to improve the accuracy of the study. A more organized approach to post-intervention would also have yielded more data collection. The suggestion was to hold post-intervention in a meeting like the pre-intervention was set up instead of handing out the questionnaire and hoping they would be returned. Lastly, the need for studies focusing more directly on measurable patient outcomes is needed to quantify the impact of SBAR communication styles beyond just a working relationship.

This study provided highly applicable information to our PICO question given the involvement of acute care physician-nurse communication being the basis of the study and the suggestion that further studies on measurable patient outcomes should be initiated.

Study Two

This study was done to analyze communication styles between nurses and doctors and implement strategies for improving communication and collaboration. Two groups of nurses and physicians were chosen at one facility in the Midwest. One group consisted of 34 nurses and 12 physicians and the other had 37 nurses and 22 physicians. The two groups systematically implemented collaborative rounding or written communication about patients on central clipboards, and representatives from each group then met with each other for eight hours over four weeks to discuss progress. At the end of the study, it was found that, within these groups, both nurses and physicians reported being able to communicate better and more accurately.

This study is relevant to our question in that it addresses the need to have more effective and accurate communication in order to elevate patient outcomes, even though it did not directly measure patient outcomes or satisfaction. Although this study did have some success in improving communication, it was noted that there were limitations in sample size and duration of study.

Study Three

The purpose of this study was to identify ways to minimize adverse patient outcomes due to poor communication or miscommunication between nurses and physicians in intensive care units. To identify these problems the study selected 25 Intensive Care Units (ICU) from several different institutions in Southeast Michigan. The units differed from large urban to single ICU centers. The study was only done with Intensive Care Units and specifically with patients that had ventilator associated pneumonia, bloodstream infections associated with central catheters and pressure ulcers. The research concluded that not all elements of communication were negatively related to a patients condition. The study also concluded that a larger sample area is needed. In addition to that, with a larger area there may be significant communication influences related to pressure ulcers. However, it was suggested that communication between nurses and physicians is just one aspect of undesirable results in patient care and there are other processes that are more closely linked to adverse outcomes, but this area is rarely researched.

This study was highly pertinent to our question in that it directly examined patient outcomes regarding communication between nurses and doctors. Though the results of the study were inconclusive, it was interesting to note the suggestion of communication being only one piece of the patient care puzzle.

Study Four

This study was done in order to identify and mitigate ineffective communication between doctors and nurses in order to improve patient outcomes. It did this by performing a literature review of fifty-three articles related to ineffective communication focusing on five aspects of doctor-nurse relationships including traditional hierarchical roles, expanding workloads, mobility of the workforce, differing perspectives and language barriers, and experience level of those involved. To combat these barriers, they recommend a four part effective communication guide for nurses to use when talking with doctors. Suggestions include recognizing your current emotional state and the state of those with whom you are communicating, planning what you want to achieve and anticipating the needs of the other person, using a structured approach to make sure important details are covered, and utilizing graded assertiveness to amplify concern in a systematic manner.

This study was pertinent to our question regarding communication affecting patient outcomes, and very helpful in suggesting ways to communicate better and more effectively.

Study Five

This study was conducted to improve patients perception of quality and influence improvement in health care provider efficiency. It was conducted on a 45 bed medical unit in a 350 bed trauma hospital in a large Midwestern city with the hospitalist group that rounded on this medical unit and the nurses caring to that unit. Patients were randomly chosen from this unit and no criteria were used. The results of this study showed that nurses and physicians agreed that the project improved quality of care and communication, but did not eliminate the need to further communicate after rounds. Although some physicians thought that this improved patients perception of quality of care there was no evidence stating so. A major factor in this study was to see if nurse-physician rounding would reduce the amount of calls the hospitalists received after implementing the collaborative rounds. The logs kept of calls were taken from the entire hospital and not just the medical unit, so the logs were not reflective of the study. Overall, the study showed that nurse-physician rounds had the potential for positive impact, but more studies need to be done.

For this study to be more valid to the research question, the surveys should have been taken by the patients that received care and not by the physicians. A more structured study that correlates nurse-physician communication with each individual patients quality of care would be more relevant to the research question.

Study Six

This article wasnt a study but a professional discussion about effective communication between health care team members focusing on labor and delivery. It gave an example of a typical scenario between a physician and a nurse in a labor and delivery unit. It indicated that effective communication is essential to patient safety. The target population was physicians and nurses. The recommendations given by the article for improvement of nurse-physician communication are to set aside assumptions and address potential conflicts early. It also suggests that effective communication is clear, direct, explicit and respectful. Since it was not a study, there is no evidence, just professional opinion. It was a discussion of effective communication styles.

Summary of Evidence and Practice Recommendation

While most of the studies suggested that poor communication between the nurse and physician has an adverse impact on patient outcomes, they also indicated that more studies were needed prove the efficacy of standardized communication interventions. Plus, participation and completion rate of the participants was low in some of the studies, suggesting non-compliance or people reluctant to change current systems or behaviors. Also, most studies stopped short of analyzing patient outcomes as they related to communication between the nurses and physician. Perhaps a more extensive study that tracks nurse-physician communication used with individual patients, then follows up with that patient to determine quality of care would be an appropriate evaluation of our PICO question.

Conclusion

All of the studies that involved testing a hypothesis in a given sample of people indicated the need for larger samples and a study of longer duration. Intuitively, any standardized communication that can be consistently implemented should help with clearer, more precise patient care, and, therefore better patient outcomes. Whether members of the health care team use collaborative rounding, SBAR communication, graded assertiveness, or another form of communication, if it is adopted by everyone on the team consistently, it will help ensure important details get passed on to each member of the health care team, and thus the patient will receive better quality of care.

ReferencesAebersold, M., Averhart, V., Keenan, G., Kocan, M. J., Lundy, F., Tschannen, D. (2011). Implications of Nurse-Physician Relations: Report of a Successful Intervention. Nursing Economics. May/Jun 2011, Vol. 29 Issue 3, p127-135. 9p. 1 Diagram, 4 ChartsAntonakos, Cathy L., Manojlovich, Milisa, Ronis, David L. (2009). Intensive Care Units, Communication Between Nurses and Physicians, and Patients Outcomes. American Journal of Critical Care, 18(1), 21-30. doi: 10.4037/ajcc2009353Beckett, C. D., & Kipnis, G. (2009). Collaborative Communication: Integrating SBAR to Improve Quality/Patient Safety Outcomes. Journal for Healthcare Quality, 31(5). 19-28. Doi: 10.1111/j.1945-1474.2009.00043.x Burns, K. (2011). Professional Issues. Nurse-Physician Rounds: A Collaborative Approach To Improving Communication, Efficiencies, and Perception of Care. MEDSURG Nursing, 20(4), 194-199. Curtis, K., Tzannes, A., Rudge, T. (2011). How to talk to doctors a guide for effective communication. International Nursing Review 58, 13-20Lyndon, A., Zlatnik, M., & Wachter, R. (2011). Effective physician-nurse communication: a patient safety essential for labor and delivery. American Journal Of Obstetrics And Gynecology, 205(2), 91-96. doi:10.1016/j.ajog.2011.04.021

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