The Effect of Nurse-Physician Communication on the Qualityof Patient Care

This is a literature review of six studies related to the PICO formulated question: Among acute care nurses does inconsistent communication with admitting physician affect the quality of patient care throughout the duration of stay? The article databases CINAHL, Cochrane, Medline, and Pubmed were searched for articles related to cohort, case control, descriptive, qualitative, and systematic review studies. The search terms garnered from the PICO question included: patient care, admitting physician, nurses, acute care, communication, published 2008-present and excluding the term long term care.

Evidence

Study 1

This study was done to analyze communication styles between nurses and doctors and implement strategies for improving communication and collaboration. At a facility in the Midwest, 2 groups containing nurses and physicians (one with 34 nurses and 12 physicians and the other had 37 nurses and 22 physicians) participated. The groups implemented collaborative rounding or written communication about patients on central clipboards, and representatives then met for eight hours over four weeks to discuss their progress. At the end of the study it was reported that both nurses and physicians were able to communicate more accurately.

Study 2

The purpose of this study was to identify ways to minimize adverse patient outcomes due to poor communication between nurses and physicians in intensive care units. This study selected 25 Intensive Care Units from several different institutions in Southeast Michigan and focused on patients that had ventilator associated pneumonia (VAP), bloodstream infections associated with central catheters, and pressure ulcers. There was statistical data that showed when the timeliness of communication increased, the incidence of pressure ulcers was reduced. It was also found that when there was poor understanding in directions of care between the nurses and physicians, there was a greater incidence of VAP.

Aebersold, M., Averhart, V., Keenan, G., Kocan, M. J., Lundy, F., Tschannen, D. (2011). Implications of Nurse-Physician Relations: Report of a Successful Intervention. Nursing Economics. May/Jun 2011, Vol. 29 Issue 3, p127-135. 9p. 1 Diagram, 4 Charts.

Antonakos, Cathy L., Manojlovich, Milisa, Ronis, David L. (2009). Intensive Care Units, Communication Between Nurses and Physicians, and Patients’ Outcomes. American Journal of Critical Care, 18(1), 21-30. doi: 10.4037/ajcc2009353

Beckett, C. D., & Kipnis, G. (2009). Collaborative Communication: Integrating SBAR to Improve Quality/Patient Safety Outcomes. Journal for Healthcare Quality, 31(5). 19-28. Doi: 10.1111/j.1945-1474.2009.00043.x

Curtis, K., Tzannes, A., Rudge, T. (2011). How to talk to doctors – a guide for effective communication. International Nursing Review 58, 13-20

Burns, K. (2011). Professional Issues. Nurse-Physician Rounds: A Collaborative Approach To Improving Communication, Efficiencies, and Perception of Care. MEDSURG Nursing, 20(4), 194-199.

Lyndon, A., Zlatnik, M., & Wachter, R. (2011). Effective physician-nurse communication: a patient safety essential for labor and delivery. American Journal Of Obstetrics And Gynecology, 205(2), 91-96. doi:10.1016/j.ajog.2011.04.021

Cooley, Amanda; Despain, Ora; Elder, Tessa; Hyatt, Adam; May, Spencer; Steed, Libbey

Dixie State University

Background

Evidence (cont.)Conclusion

References

Funding Source: First Person

Second Contributor

While most of the studies suggested that poor communication between the nurse and physician has an adverse impact on patient outcomes, they also indicated that more studies were needed prove the efficacy of standardized communication interventions. Participation and completion rate of the participants was low in some of the studies, suggesting non-compliance or people reluctant to change current systems or behaviors.

All of the studies that involved testing a hypothesis in a given sample of people indicated the need for larger samples and a study of longer duration. Intuitively, any standardized communication that can be consistently implemented should help with clearer, more precise patient care, and, therefore better patient outcomes. Whether members of the health care team use collaborative rounding, SBAR communication, graded assertiveness, or another form of communication, if the method is adopted by everyone on the team consistently, it will help ensure important details get passed on to each member of the health care team, and thus the patient will receive better quality of care.

Study 3

The purpose of this study was to evaluate the effectiveness of SBAR collaborative communication for best practice. 215 staff and 30 physicians in a pediatric/perinatal unit on a 271 bed hospital in Arizona were involved in a convenience sample study. Data was gathered through pre/post intervention questionnaires. The quantitative analysis revealed that 18 out of 27 items from the questionnaires were significantly statistically different in the post-intervention compared to the pre-intervention. Qualitative analysis suggested SBAR-CCE improved physician-nurse communication and relations, which in turn improved patient safety outcomes, although no specific safety outcomes were cited or measured.

Study 4

This study was done in order to identify and mitigate ineffective communication between doctors and nurses in order to improve patient outcomes. It did this by performing a literature review of fifty-three articles related to ineffective communication focusing on five aspects of doctor-nurse relationships including: traditional hierarchical roles, expanding workloads, mobility of the workforce, differing perspectives and language barriers, and experience level of those involved. To combat these barriers, they recommend a four part effective communication guide for nurses to use when talking with doctors. Suggestions include: Recognizing your current emotional state and the state of those with whom you are communicating, planning what you want to achieve and anticipating the needs of the other person, using a structured approach to make sure important details are covered, and utilizing graded assertiveness to amplify concern in a systematic manner.

Study 5 This study was conducted to improve patients perception of quality and influence improvement in health care provider efficiency. This study was conducted on a 45 bed medical unit in a 350 bed trauma hospital in a large Midwestern city with physicians and nurses caring for patients. The results of this study showed that nurses and physicians agreed that the project improved quality of care and communication, but did not eliminate the need to further communication after rounds.

Study 6

This article wasn’t a study but a professional discussion about effective communication between health care team members focusing on labor and delivery. It gave an example of a typical scenario between a physician and a nurse in a labor and delivery unit. It indicated that effective communication is essential to patient safety. The target population was physicians and nurses. The recommendations given by the article for improvement of nurse-physician communication are to set aside assumptions and address potential conflicts early. It also suggests that effective communication is clear, direct, explicit and respectful. Since it was not a study, there is no evidence, just professional opinion. It was a discussion of effective communication styles.

Study 1 T-Test Comparison

Among acute care nurses does inconsistent communication with admitting physician affect the quality of patient care throughout the duration of stay?Among acute care nurses does inconsistent communication with admitting physician affect the quality of patient care throughout the duration of stay?