Interruptive communication patterns in the intensive care unit ward round
Introduction
Several studies have highlighted that poor communication between healthcare workers contributes significantly as a latent source of medical error [1], [2], [3]. Furthermore, evidence exists that patients have better outcomes when nurses and doctors communicate effectively [4], [5], [6]. Past research has illustrated that interruptive communication seems to dominate in high stress medical environments. Chisholm et al. studied emergency department physicians and showed that per 180-min observation, there were a mean of 30.9 ± 9.7 interruptions [7]. An Australian study showed that doctors and nurses spent 80% of their time communicating and that 30% was considered interruptive [8].
The intensive care unit (ICU) is an area of the hospital where the sickest patients reside. Poor communication is perceived as a significant root cause of error in ICU [9], [10]. However, little observational data regarding communication in the ICU exists. This study explores the patterns of communication between healthcare workers during intensive care ward rounds and focuses on interruptions, which may disrupt working memory and as a consequence cause clinical errors [30].
Section snippets
Method
The study was conducted at the intensive care unit of a large metropolitan teaching hospital located in Sydney, NSW, Australia. The hospital is a trauma center with over 500 hospital beds and 12 intensive care beds (ICU). All observations occurred during the daily morning or evening ward rounds. This is typically the busiest times of the day when all patients are examined and many management decisions are made. The observations occurred between June 2002 and February 2003. Prior to recruitment
Results
Subjects were observed for a total of twenty-four hours, and communication events accounted for 17.5 h of the total time observed.
Discussion
To our knowledge, no previous study has examined the communication patterns of the intensive care ward round, nor analysed for turn-taking interruptions. Our results support previous findings of high interruptive communication patterns in the clinical domain. Over a third of communication events in this study were classified as communication-initiating interruptions, similar to the 30.6% interruption rate reported in a previous study of two Australian emergency departments [8]. A separate study
Conclusion
These results suggest that intensive care personnel spend the majority of their time in the ward round communicating and that interruptions are prevalent. Turn-taking interruptions are well documented in other arenas, but this study highlights that they are a significant and previously unanticipated additional source of disruption to clinical activity. Clearly some types of interruption are necessary, and further research is required to understand the specific consequences of different
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