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Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study
  1. Milisa Manojlovich1,
  2. Molly Harrod2,
  3. Timothy Hofer2,3,
  4. Megan Lafferty1,
  5. Michaella McBratnie1,
  6. Sarah L Krein2
  1. 1School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  3. 3Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Milisa Manojlovich, School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA; mmanojlo{at}umich.edu

Abstract

Background How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units.

Methods Using a qualitative design, we collected data through observation, shadowing, interviews and focus groups of bedside registered nurses and physicians who worked in four hospitals in the Midwest USA. We analysed the data using inductive content analysis.

Results A total of 155 physicians and nurses participated. Eighty-six nurses and 32 physicians participated in focus groups or individual interviews; we shadowed 37 physicians and nurses across all sites. Two major inter-related themes emerged, message and non-message related factors. Message-related factors included the medium nurses used to convey messages, physician preference for notification via one communication medium over another and the clarity of the message, all of which could cause confusion and thus a delayed response. Non-message related factors included trust and interpersonal relationships, and different perspectives between nurses and physicians on the same clinical issue that affected perceptions of urgency, and contributed to delays in responsiveness.

Conclusions Physician responsiveness to communications from bedside nurses depends on a complex combination of factors related to the message itself and non-message related factors. How quickly physicians respond is a multifactorial phenomenon, and strategies to promote a timely response within the context of a given situation must be directed to both groups.

  • patient safety
  • communication
  • health services research
  • hospital medicine
  • information technology
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Footnotes

  • Twitter @mmanojlo, @Sarahlkrein

  • Contributors MM conceived the idea. MM, ML, SLK were involved in data collection. All authors were involved in data analysis and interpretation. MM drafted the article. All authors were involved in critical revision of the article and gave final approval of the version to be published.

  • Funding This project was supported by grant number R01HS022305 from the Agency for Healthcare Research and Quality (AHRQ).

  • Competing interests TH, SLK and MM reports grants from the AHRQ during the conduct of the study. TH and SLK reports grants from the Department of Veterans Affairs, Health Services Research & Development Service, during the conduct of the study.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Deidentified participant data are available from the first author on request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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