1. 1. TINA C. SANJAR, MD SOUTH MIAMI INPATIENT PHYSICIANS INTERNAL MEDICINE/HOSPITALIST SOUTH MIAMI HOSPITAL COMMUNICATION
2. 2. WHY IT MATTERS EFECTIVE COMMUNICATION IS THE FOUNDATION OF EXCELLENT PATIENT CARE We must learn to communicate in ways that establish therapeutic relationships and support successful interventions. Affects quality of care, efficiency, and patient outcomes Improved quality of life, mood, improved understanding of patient goals, and survival. Patient Safety (Decreased Error Rates) Safer Handoffs
3. 3. HOSPITALISTS Fastest growing specialty in medicine with 1,000 in mid-1990s to over 28,000 by 2009 Percent of Internal Medicine physicians practicing as hospitalists was 19% in 2006 Care of higher acuity and complex patients Absence of established physician/patient relationship Limited or no past medical history available Work load
4. 4. HOSPITALISTS COMMUNICATION HAS BECOME AN ESSENTIAL COMPETENCY FOR HOSPITALISTS Limited professional interaction with outpatient providers Lack of standardized hand-off procedures Poor communication among care team, especially during transfer of care
5. 5. WHY IT MATTERS TO HOSPITALISTS Approximately 98,000 hospitalized patients die as a result of a medical error in the U.S. each year Communication failure has been found to be the root cause in nearly 70% of these events Because of this, one of the Joint Commissions 2008 National Patient Safety Goals is to improve the effectiveness of communication among caregivers.
6. 6. MISCOMMUNICATION THE GREATEST PROBLEM WITH COMMUNICATION IS THE ILLUSION THAT IS HAS BEEN ACCOMPLISHED. GEORGE BERNARD SHAW
7. 7. COMMUNICATION ISSUES HUMAN FACTORS Fatigue Distractions Cognition Anchoring Conflict HANDOFF ISSUES Communication Breakdown Lack of continuity of care Lack of follow-up care No definitive leader
8. 8. MISCOMMUNICATION In general, the most common problems are caused by relatively simple errors faults in common courtesy, failures in listening or acknowledging [] needs. Robert Buckman
9. 9. ORGANIZING COMMUNICATIONS What is important to communicate? Who needs to know what information? When should communication occur? How should the information be transmitted? Is there an opportunity for the receiver of the information to ask questions? How can you validate the communication was successful?
10. 10. COMMUNICATION STRATEGIES Effective Communication Strategies Read Back/Repeat Back (Teach Back) Standardized Protocols/Procedures Especially during transfers of care
11. 11. Effective Communication Strategies Open-Ended Questions Opportunity for more information. Closed questions rarely elicit additional information, except when specific information is needed. What else can you tell me? Minimal Leads and Accurate Verbal Following These indicate interest and encourage continued talking. These can also be non-verbal, e.g. nodding, eye contact, leaning in, etc. Uh-huh Hmmm Oh? And? Then? Repetition Involves repeating one or two key words to indicate you are listening. This also encourages continued talking and enhances the sense of being heard. Repetition does not mean that there is understanding or agreement; just that there is listening, so this is a technique that should be mixed with other techniques. When I take the pills I feel nervous. The pills make you feel nervous.
12. 12. Effective Communication Strategies Paraphrasing and Reflecting This involves repeating a statement in your own words to ensure the message is understood. Read Back/Repeat Back Clarifying Responses This helps better understand the facts, feelings, and attitudes behind statements and also helps people to think about what they have just said. It leads to examination of choices and patterns. Is it possible that you feel? Can you give me an example of?
13. 13. Effective Communication Strategies Confrontation and Honest Labeling This is a technique that explores uncomfortable subjects such as distortions of reality or differences between words and actions. Integrating and Summarizing These are techniques that ensure that main concerns are understood. They help clarify thoughts and feelings and encourage further exploration of confusing issues. Let me see if I understood what you have told me
14. 14. THE HOSPITALISTS DUTY Hospitalists must be respectful of others experience level. A hospitalist should also communicate changes in a patients plan of care with all pertinent care- team members. Listening before making a decision. Developing standardized hand-off procedures for continuity of care. Organized Rounds
15. 15. A FORMAL STRATEGY FOR ALLIED PROFESSIONALS One such strategy was found in a communication model used by the Navy in their nuclear submarine division. This model is called the SBAR Offers a simple way to standardize communication Creates a common language Promoted by: The Joint Commission The World Health Organization (WHO)
16. 16. SBAR COMMUNICATION SITUATION What is happening at the present time? BACKGROUND What are the circumstances leading up to this situation? ASSESSMENT What are the conclusions about the present situation? RECOMMENDATION What should be done to correct the problem? Most challenging step. REPEAT BACK Repeat back the plan of care.
17. 17. SBAR COMMUNICATION Situation Identify the person to whom you are speaking Identify yourself, occupation, and where you are calling from Identify the patient by name and reason for admission Identify what is going on with the patient (Chest pain, nausea, etc...) Background Give the patient's presenting complaint Give the patient's relevant past medical history Brief summary of background Assessment Vital signs: heart rate, respiratory rate, blood pressure, temperature, oxygen saturation, pain scale, level of consciousness List if any vital signs that are outside of parameters; what is your clinical impression Severity of patient, additional concern Recommendation Explanation of what you require, how urgent and when action needs to be taken Make suggestions of what action is to be taken Clarify what action you expect to be taken
18. 18. RECOMMENDATION STEP Based on your assessment data and knowledge of your patient, offer a Recommendation to the physician. The Recommendation is one possible solution from your vantage point. This Recommendation may not be accepted by the person receiving the message, but is a starting point to discuss solutions.
19. 19. SBAR CLINICAL SCENARIO #1 RN/Respiratory Therapist Calling MD Regarding Patients SOB S Mr. Smith is short of breath. B Hes a 3 day post op colon resection patient who has been on room air. A Im concerned because he has labored breathing, decreased breath sounds on the right side, a RR of 36, and O2 Sat of 85% on room air. R He is on supplemental O2 now. Should we get a stat chest x-ray?
20. 20. SBAR CLINICAL SCENARIO #2 RN/Physical Therapist communicating with physician about patients calf pain S Mrs. Gomez complains of pain in her right leg every time her Sequential Compression Device (SCD) inflates. B She is 3 days post op right hip replacement and has not ambulated due to other medical complications. A Her right calf is red with mild swelling. I suspect a deep vein thrombosis (DVT). R Should we put her on bed rest until you can evaluate her?
21. 21. SBAR CLINICAL SCENARIO #3 RN/Respiratory Therapist Calling MD Regarding SOB and Chest Pain S - Mrs. Smith is having increasing dyspnea and is complaining of chest pain. B - She had a total knee replacement two days ago. About two hours ago she began complaining of chest pain. Her pulse is 120 and her blood pressure is 128/54. She is restless and short of breath. A - She may be having a cardiac event or a pulmonary embolism. R - I started her on O2, should I order cardiac enzymes or an ABG?
22. 22. SBAR PREPAREDNESS Communication works for those who work at it. John Powell Some preparation is needed to communicate with SBAR: Gather relevant information (e.g. chart, labs, MAR, etc.) Formulate your thoughts in a concise manner Practice with a colleague
23. 23. COMMUNICATION Almost invariably, the act of communication is an important part of therapy; occasionally it is the only constituent. It usually requires greater thought and planning than a drug prescription, and unfortunately it is commonly administered in sub-therapeutic doses. Robert Buckman
24. 24. THE END GOAL
25. 25. THE END THANK YOU!!!!
26. 26. REFERENCES Communication and Teamwork. UNIPAC 5: A Resource for Hospice and Palliative Care Professionals. Toby C. Campbell, MD and Gordon J. Wood, MD. Edited by C. Porter Storey, Jr., MD. Fourth Edition Miss Communication: Tips to mitigate breakdowns between hospitalists and care teams, Lisa Ryan. The Hospitalist, Volume 16, No. 12, December 2012. Understanding Hospitalist Communication Risks. The Doctors Company. http://www.thedoctors.com/ecm/groups/public/@tdc/@web/@kc/ @seminars/documents/web_content/id_011828.pdf Communication Using the SBAR Model. Sharp Healthcare. December 2007. http://www.sharp.com/b2b/students/upload/SBAR-Self-Learn.pdf Farnan, J.M., et al. Effective Communication in the Inpatient Care Setting: An Essential Competency for Hospitalists. Seminars in Medical Practice, 2006, Vol. 9, 21-28.