[Who communicates with whom? General practitioners' contacts with the municipalities and the secondary health care system].
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Community Health Services↗
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Communication with referring physicians in a palliative radiotherapy clinic.
GOALS: The rapid response radiotherapy program (RRRP) at Toronto-Sunnybrook Regional Cancer Center (TSRCC) provides quick access to palliative radiotherapy for patients with a life expectancy of less than 12 months. Patients then return to their referring physician for continued oncologic management. After the initial RRRP consultation, we fax an interim consultation report to the referring physician. The purpose of this study was to assess how useful referring physicians perceive this interim report and whether this report needs to be modified to meet their information needs. METHODS: Physicians who referred patients to the RRRP and who were faxed an interim consultation report were identified over a 4-month period. These physicians were then faxed a questionnaire that asked how useful the interim report was in patient management, about their satisfaction with the information provided, to critique the report format, and whether the RRRP physician and nurse were easily accessible by telephone. MAIN RESULTS: Forty physicians referred patients to the RRRP clinic over the 4-month study period. The response rate to our survey was 58% (23/40). The vast majority of physicians (95%) stated that the interim consultation report was useful in patient management. They felt that treatment details were adequately discussed in the report. The report format was perceived to be clear and concise. Referring physicians wished to be informed about any medication changes. RRRP physicians and nurse were perceived to be easily accessible by telephone if needed. CONCLUSIONS: Results showed that referring physicians found the faxed interim consultation report useful in patient management. Suggestions were made on how to improve the report, and they will be used to further enhance physician communication and ultimately patient care.
Cancer Care Facilities↗
Training multiprofessional trauma teams in Norwegian hospitals using simple and low cost local simulations.
CONTEXT & OBJECTIVE: Norwegian hospitals' trauma teams are seldom exposed to severely injured patients. We developed and implemented a one-day multi-professional training course for hospital trauma teams in order to improve communication, cooperation and leadership. METHODS: Training courses were held in 28 Norwegian hospitals with learning objectives: improved team work, common understanding of treatment priorities and principles, communication skills, and threats to efficient communication. Two trauma teams in each hospital had two consecutive simulations in their hospital's own emergency room, as part of the course. Simulation was based on real cases, with a low-fidelity mannequin as patient. Participants completed questionnaires before and after the training course. RESULTS: A total of 2,860 trauma team members participated in the courses, of which 1,237 took part in the simulation. Independent of hospital size, the participants reported leadership and communication to be major obstacles during their last real trauma team participation. Immediately after the training, all participants reported highly fulfilled educational expectations and a high perception of learning, and taking part in the practical simulation improved the evaluation. Nurses scored their outcome significantly higher than physicians. Participants from minor hospitals reported as great a benefit from the training as personnel from major hospitals. CONCLUSIONS: Local team training is a feasible approach and team simulation offers an excellent opportunity to practise demanding and infrequent challenges. The simulation format makes it possible to integrate training on interpersonal skills as well as communication and leadership under stress. Continued requests for such training in Norway support this conclusion.
Cooperative Behavior↗
Interdisciplinary telecommunication and expert teleconsultation in diagnostic pathology: present status and future prospects.
Telepathology can be performed in an active or a passive manner. There are two main types: interdisciplinary telepathology and expert teleconsultations. Interdisciplinary telepathology involves a pathologist and another specialist (e.g. a radiologist or endoscopist). It is mainly used in an active manner (i.e. online and in realtime) and has three purposes: to ensure correct tissue sampling, to provide additional diagnostic information to the pathologist, or to facilitate collaborative therapeutic or diagnostic decision making between the clinician and pathologist. Expert teleconsultations, typically between two pathologists, are mainly undertaken in passive mode (i.e. offline and using store-and-forward techniques). The Internet often serves as a platform for both types of telepathology application. Experience with interdisciplinary telepathology is rare at present and is usually limited to partners at a local institution. The efficiency and accuracy of expert teleconsultations in telepathology have been demonstrated in numerous studies. In future, the application of expert teleconsultation in pathology will expand, with the Internet as the communications medium. Interdisciplinary telepathology is a promising technique to improve diagnostic quality.
Diagnostic Services↗
Reflections and perspectives.
Complex patients who have biopsychosocial comorbidities represent a major challenge for the current health care system. Unlike standard medical situations for which medical care can be based on an evidence-based approach, complex patients require a broader concept of care. As demonstrated throughout this issue, such an integrated approach that takes into account the concepts of case- and care complexity is not only possible, it is cost-effective. Integrated care, however, needs assessment tools and a communications-based approach that fosters exchange and collaboration between different medical disciplines and professions and patients.
Decision Support Systems, Clinical↗
Sterilization, Catholic health care, and the legitimate autonomy of culture.
Disagreement over the legitimacy of direct sterilization continues within Catholic moral debate, with painful and at times confusing ramifications for Catholic healthcare systems. This paper argues that the medical profession should be construed as a key moral authority in this debate, on two grounds. First, the recent revival of neo-Aristotelianism in moral philosophy as applied to medical ethics has brought out the inherently moral dimensions of the history and current practice of medicine. Second, this recognition can be linked to Catholic morality through Vatican II's affirmation of the legitimate autonomy of culture, including the sciences. A partial precedent for understanding the moral authority of medicine can be found in the recent history of Catholic medical morality, and we further argue that a full contemporary recognition of that authority would weigh against an absolute prohibition of direct sterilizations. Institutionally, we propose the allowance of direct sterilizations in cases where the clinically perceived biomedical good of the patient is at stake.
Altruism↗
Of towers, walls, and fields: perspectives on language in science.
Language in science is in the midst of change and appears dominated by two contradictory trends. Globalization of scientific English seems to promise greater international unity, while growth of field-specific jargon suggests communicational diaspora. Real in part, each trend is complex and multileveled, and includes elements of convergence and divergence, along with important implications for the present and future of technical knowledge.
Interdisciplinary Communication↗
Main barriers to effective handoffs identified.
Distractions such as lighting and background noise can significantly impair communications. Leaders must empower interns to raise appropriate questions with more senior staff. Authors recommend incorporation of handoff tools into existing information technology systems.
Continuity of Patient Care↗
Reconciliation failures lead to medication errors.
Poor communication of medical information at transition points of care--at admission, transfer, and discharge--often results in medication errors, but various strategies can reduce the likelihood of error.
Documentation↗
Evaluation of immediate discharge documents--room for improvement?
BACKGROUND: The Immediate Discharge Document is a tool used to communicate patient discharge information between hospitals and general practitioners. The standard of information provided may be variable, and sometimes delayed in arriving at the GP practice. Typed communication from the hospital can also be slow. This can result in difficulty managing patients in the community following their discharge. Our aim was to assess the quantity of information provided on Immediate Discharge Documents, and to assess the time scale taken for GPs to receive written communications from hospitals regarding patient discharges. An audit was initiated using a tool devised from Scottish Intercollegiate Guidelines Network Publication no 5 and involving four general practices within City of Perth, Scotland. Data was collected over a 28-day period in June/July 2001, by examining Immediate Discharge Documents relevant to each practice population received during this period, and by noting the time of arrival of a final typed summary. Data was analysed by Tayside Audit Resource for Primary Care. A total of 244 Documents were audited. Most significant results include basic administrative detail lacking in up to 30%. Of total documents, 13% failed to record a main condition or diagnosis; 93% recorded drug information, but only in 28% were follow up plans clear; 60% were received within five days of discharge, whilst final typed summaries were received from the hospitals within four weeks only in 51%. CONCLUSION: These results show there to be room for improvement with regard communication of patient discharge information, in regard to both the content of information provided and the time it takes to arrive. We require to raise awareness of this problem amongst hospital colleagues involving clinical governance and audit staff, with the objective to improve the quality and timescale of information transfer. WHERE THIS PIECE FITS: It is known that effective information transfer between health professionals is vital to optimise patient care. This work gives further impetus to improve the current standard of communication, and confirms a significant time delay that it takes information to reach GPs from the hospital setting.
Continuity of Patient Care↗
Transcending intractable conflict in health care: an exploratory study of communication and conflict management among anesthesia providers.
This paper explores the contrast between the longstanding, intractable conflict between two anesthesia providers and the cooperation of many individual nurse anesthetists and anesthesiologists working side-by-side to provide safe, effective anesthesia. Analysis of interview transcripts reveals that communication among anesthesia nurses and anesthesiologists may enact or transcend the conflict. This article proposes recommendations for improving communication between anesthesiologists and certified registered nurse anesthetists in particular and de-escalating intractable conflict in general. It also contributes to communication theory in intractable conflict by examining how individual, interpersonal conflict management interactions lead to either transcendence or enactment of the larger group conflict.
Anesthesiology↗
A cross-cultural survey of residents' perceived barriers in questioning/challenging authority.
OBJECTIVES: To identify perceived barriers to residents' questioning or challenging their seniors, to determine how these barriers affect decisions, and to assess how these barriers differ across cultures. METHOD: A written questionnaire was administered to residents in teaching hospitals in the US and Japan to assess factors affecting residents' willingness to question or challenge their superiors. The responses were analyzed for statistical significance of differences between the two cultures and to determine the importance of issues affecting decisions. RESULTS: Questionnaires were completed by 175 US and 65 Japanese residents, with an overall response rate of 71%. Trainees from both countries believe that questioning and challenging contribute to safety. The perceived importance of specific beliefs about the workplace differed across cultures in seven out of 22 questions. Residents' decisions to make a challenge were related to the relationships and perceived response of the superiors. There was no statistical difference between the US and Japanese residents in terms of the threshold for challenging their seniors. CONCLUSION: We have identified attributes of residents' beliefs of communication, including several cross-cultural differences in the importance of values and issues affecting one's decision to question or challenge. In contrast, there was no difference in the threshold for challenging seniors by the Japanese and US residents studied. Changes in organizational and professional culture may be as important, if not more so, than national culture to encourage "speaking up". Residents should be encouraged to overcome barriers to challenging, and training programs should foster improved relationships and communication between trainers and trainees.
Attitude of Health Personnel↗
Reforming the law in action through empirically grounded civil commitment guidelines.
Some assumptions that guided the national task force in developing the Guidelines for Involuntary Civil Commitment are identified and discussed. The task force's multidisciplinary membership is seen as enhancing the credibility of the suggested reforms. The task force developed guidelines instead of a model law, avoiding disputes about the philosophical basis of commitment laws and providing local jurisdictions the liberty to adapt the task force's recommendations to suit local conditions. Both the problems identified and the suggestions offered by the guidelines were based on the empirical experience of local commitment systems. Communication among the components of civil commitment systems was seen as crucial to reform and as achievable through a recommended structural change.
Advisory Committees↗
Hormesis and risk communication: a comment to Ortwin Renn.
Professor Ortwin Renn should be congratulated for authoring the definitive piece on risk communication with regard to hormesis. Most of his conclusions I agree with, specifically the importance of labelling hormesis as a possible natural effect, thereby reducing the stigmatization associated with a technical/chemical label. Rather than discussing all the points that Renn raises, in this comment I will focus on the issue of trust, a topic that Renn does examine but which I feel does not get adequate attention and which I do not completely agree with. In so doing, in my conclusions I am more optimistic than Renn is in preparing risk communication strategies regarding hormesis and other new paradigms to target audiences (defined in most instances as the general public and stakeholders).
Animals↗
Communicating critical values in anatomic pathology.
Critical values in anatomic pathology are usually information sensitive, whereas most such values in laboratory medicine are time sensitive. However, there is an important time element in anatomic pathology as well. Pathologists should be aware that many medicolegal actions against radiologists are based on failure to communicate "abnormal" results in a timely manner. Are pathologists the next group that will be targeted? Pathologists can spend much time trying to communicate important data that will affect patient care to someone who will accept the information. This is not an efficient use of pathologists' professional time. Most important, what are our obligations to patients to communicate "critical" abnormal results to the treating physician? What results need to be so communicated? Are pathologists obliged to contact the patient directly if there is a failure to communicate the critical results to a clinician? We explore these questions to promote discussion of these important issues as they relate to pathologists' liability and to patient care.
Humans↗
Anthropology and bioethics.
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Anthropology↗
Pediatricians' views about oral health care.
Pediatricians and family practitioners have the responsibility of providing the crucial primary care for the children. They are considered to be in a unique position to contribute to the dental health of their young patients. In view of this a study was conducted in Mangalore city (India) to assess pediatricians' views about oral health care and their advice regarding oral hygiene maintenance. Fifty pediatricians were personally interviewed with a questionnaire. All pediatricians acknowledged their role in oral hygiene maintenance of their patients. This study showed that there is a need for more communication between the two pediatric specialties of medicine and dentistry so as to deliver better child health care.
Attitude of Health Personnel↗
'Wet Reads' in the age of PACS: technical and workflow considerations for a preliminary report system.
Communication between clinicians, technologists, and radiologists has become more complex, with Picture Archiving and Communication Systems (PACS) now allowing the radiologist to be removed from the physical location of the patients and the site of imaging. With these changes, effective communication becomes an ongoing challenge. Efficient communication of study interpretations has also become a priority for radiologists as they struggle to maintain relevance and provide added value to patient care when clinicians have ready access to radiology images. The purpose of this paper is to share our experience in developing and implementing the Collaborative Notification System (CNS), a communication tool used to inform referring clinicians of urgent findings-a.k.a. "wet reads." The system utilizes a system of web pages integrated into PACS for the sending and receiving of succinct messages to provide clinical information at the point of need. A second system of pager alerts provides notification of the need for such communication through a relatively unintrusive, one-way, acknowledged alert system. The CNS provides asynchronous, integrated communication for the reporting of urgent and emergent radiology findings in a complex, geographically distributed medical environment.
Efficiency, Organizational↗