Download PDF: Clinical Communiqué March 2015 Edition
In this edition
Welcome to the first edition of the Clinical Communiqué for 2015.
The three cases in this edition explore the issues of communication and decision-making at the bedside. Communication is a skill that sits at the core of our working lives. We share information with our colleagues about patients, pathology and imaging results, as well as our concerns, failures, and successes. We may be interacting with others more junior, more senior, or at the same level as us, or communicating to people in other disciplines, or other healthcare sectors. In a single day’s work, many of us will exchange information countless times by email, pager, phone, and in person. So, in a complex world of multimodal interactions, how do we communicate effectively with our colleagues? More specifically, how do we use handover to transfer critical information between people in a way that allows accurate decision-making every time?
Clinical handover is defined as ‘the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis^. Each of the cases in this edition provides an example of gaps in clinical handover and the potential effects those gaps had on the clinical decisions made at the time.
Handover encompasses a broad range of information transfer, including each time a result is reported for a patient, when a patient’s care is transferred to another speciality team, or when a person or team arrives to provide assistance in an emergency.
The first case (‘Lost in translation’) shows the problems that arise when assumptions are made about the type of language or wording that is used in a handover. The second case (‘Clinical picture or digital pictures?’) illustrates some of the challenges that occur in handover between different specialities and between the ranks of junior and senior staff. The third case (‘A catastrophic cascade’) looks at communication between specialists and the impact of failing to communicate all the relevant information in a critical situation.
Communication is a two-way street and there are a number of factors that can affect the successful transfer of information. The language needs to suit the context (i.e. be given in a way that will ‘make sense’); the content needs to be inclusive (i.e. leaving nothing out that is relevant); and the information needs to be received and understood (i.e. the recipient has adequately processed all the information). Using opaque language, omitting crucial details, or a lack of comprehension by the recipient, are all common reasons that underlie poor.
One of the most important means of ensuring that good handover occurs is to implement a system that closes the communication loop. There are a number of ways of doing this. A phonecall to verify that critical information has been received. Completing a checklist to acknowledge that everything has been covered. Providing an opportunity for the receiving team to recap the information and allowing a conversation between both parties to occur. Such systems safeguard effective handover when there is urgent or time-critical information. In addition to these processes, it is essential that all the information is documented clearly and is easily retrievable.
Finally, differences in specialist knowledge and experience between two parties may influence the quality, type and comprehension of information being communicated. Therefore, these differences must be taken into account and accommodated for. The expert commentary in this edition further explores the concepts of communication and decision-making between novices and experts.
Thankyou for your feedback, we always place great value in hearing from our subscribers. Your thoughts and insights on the cases, and on issues relating to patient safety, will help guide our future directions. Once again, we hope that this edition of the Clinical Communiqué will encourage you to think about your clinical practices, talk about the cases with your colleagues, and identify the areas that could be changed in your workplace to improve patient care.