Avoiding Errors with Better Inter-provider Communication

Dr on phone -low resYou might think that you’ve been doing a great job of communicating with other providers and specialists and you’re ready to close this page and read something else. But before you do that, consider this:

A study published in the Journal of the American Medical Association (JAMA) found that there’s a big discrepancy in reports of successful communication between primary care physicians and specialists. While 69.3% of primary care providers report that they “always” or “most of the time” pass along crucial patient information to specialists, only 34.8% of specialists say that they “always” or “most of the time” receive the information. Additionally, although 80.6% of specialists say that they “always” or “most of the time” send the results of a consult back to the primary care provider, only 62.6% of providers report receiving the results.1

Clearly, there’s a problem here.

Do you know how many other providers each of your patients currently sees? Are any of them specialists? More importantly, how many of them have you had the opportunity to speak with yourself? Do you ever feel your missing important information?

There’s a lot of discussion around care coordination, but unfortunately, in the fast-paced medical environment, care coordination tends to be one of the first things to fall through the cracks. On the surface, this seems understandable. You’re busy. Your colleagues are busy. You’d rather not disturb them if at all possible, and you’d prefer not to be disturbed yourself.

But what if another provider holds the key to improving your patient’s outcome? Without the information from the other provider, you might be trying to solve a jigsaw puzzle with several missing pieces. This doesn’t do your patients any favors, and it increases the likelihood of missing a crucial diagnosis, resulting in patient harm. Good communication with other providers also sends a clear signal to patients that you are invested in their health, which improves patient satisfaction. Studies have shown that satisfied, happy patients who feel that their provider cares are less likely to sue in the event that something does go wrong.

So, what can you do to improve inter-provider communication and patient outcomes?

1. Adopt appropriate health information technology (HIT). If you don’t have up-to-date HIT, you are missing out, and even worse, so are your patients. HIT makes it easy to update patient charts quickly as well as deliver reports and results and send messages to colleagues. If you already have HIT in place, take a look at it. If it’s an obscure brand, you may want to consider replacing it with a more commonly used program that will connect you with more specialists.

2. Standardize note formats. When you send written communication, are you using a standard format, or one of your own devising? Regardless of how simple you may consider your own format to be, if it isn’t in common use, it’s an error waiting to happen. Whether you’re based in an inpatient facility or in private practice, you will need to communicate with other medical professionals, and it’s essential that they understand what you are trying to tell them. HIT may resolve formatting issues, but if you are delivering an email or hard-copy orders, use a standard format with recognizable abbreviations (or, better yet, no abbreviations at all) and codes.

3. Create a care coordinator position. Your time is valuable – no question about that. When you find yourself constantly trying to coordinate communication with other specialists, it may be helpful to create a new position and hire a care coordination specialist to manage these details. The person in this position can keep close track of incoming and outgoing communication and keep you informed so you can tend to other duties.

However, take note of two key points here. First, people get sick, and vacations are necessary, so you need to have more than one person in this position. That way, balls don’t get dropped just because a person wasn’t able to come in to work one day. Second, this isn’t a “set it and forget it” type of scenario. Your patients don’t see what happens behind the scenes, and if a communication gets missed, they won’t want to hear that it’s the fault of the care coordinator. Occasional auditing to make sure that communication is happening smoothly will be necessary.

4. Pick up the telephone and call. How quickly should communication take place? If you need results from a specialist right away, it makes no sense to send an e-mail or other electronic note and then sit back and wait. You don’t know if the message was received or if it’s stuck in some kind of limbo.

Call.

Need a response right away?

Call.

Aren’t sure you understand what the specialist is saying?

Call.

Have further questions about the results?

Call.

In an urgent situation, a phone conversation or face-to-face meeting can save a life – or at least prevent serious injury. Yes, it takes more time, but the information you gather from an actual conversation with a colleague could save you a great deal of time further down the road, improve patient outcomes, and ultimately help prevent a costly error.

You can achieve better inter-provider communication by adopting appropriate HIT, creating a care coordination position, and using the phone to communicate with specialists. The improved communication you experience will benefit you and your patients in many ways.

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1 Ann S. O’Malley and James P. Reschovsky, “Referral and Consultation
Communication Between Primary Care and Specialist Physicians: Finding Common Ground”, Archives of Internal Medicine, January 1, 2011, Vol.171, No. 1 :56–65, doi:10.1001/archinternmed.2010.480.

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