The basic goal of good communication in health care has been to ensure safety, continuity of care, and efficiency of care; communication between providers is a key element of that effort.
However, with the implementation of electronic health records (EHRs) in recent years, the opportunity for actual face-to-face communication between clinicians to inform each other of a patient’s status has diminished.
Managed care and the need to see more patients in a shorter period of time has contributed greatly to providers’ use of the EHR as the sole means of obtaining patient information prior to the patient encounter.
One often finds that the patient needs to be asked the same questions that already had been asked on intake in order to verify the reason for the visit. This takes up valuable time that might be better used to get details that would enhance the visit and make for a better patient outcome.
Mnemonics such as SBAR (Situation, Background, Assessment, Recommendation) that guide hand-off procedures in many inpatient facilities are adaptable for primary- or acute-care situations (Reisenberg LA, Leitzsch J, Little BW. Systematic review of handoff mnemonics literature. American Journal of Medical Quality. 2009;24:196-204).
Although technology might have weakened the idea that verbal patient hand-offs from one clinician to another are important, such exchanges remain key to patient care, as evidenced by the recent Ebola case at Texas Health Presbyterian Hospital Dallas.
When the patient from West Africa did not receive the diagnosis of Ebola in a timely fashion, he had the potential to infect many others with whom he had contact. The EHR was the source of information and the patient’s travel history had not been obtained by the provider making the diagnosis. We cannot be sure whether a more timely diagnosis would have made a difference in the man’s survival, but we do know that it has been a teaching moment for many practitioners and for the health-care system.
If the clinician who did the intake had simply stated to the next provider that this person had just arrived from West Africa, where there is an Ebola outbreak, a better outcome could have been achieved initially at least.
There also would have been more trust in the health-care system in general, and this hospital in particular might have had the opportunity to alert the Centers for Disease Control and Prevention (CDC) before the situation became emergent.
What can nurse practitioners (NPs) and physician assistants (PAs) learn from this sentinel event? The legal implications of the EHR have great impact on the provider when this record is the only source used to obtain background information and updates on a patient.
A crucial piece of information delivered during a verbal hand-off may be small but if not conveyed, the consequences could be devastating, as with the index Ebola patient.
In patient care, all forms of communication are equally valuable, and none should be left out simply to stay on schedule or to bring in more money. Documentation, report, and hand-off, as well as the EHR, all improve patient care and continuity of care so that the system works better for all of us.
NPs and PAs should stand strong in communicating with all members of the health-care team rather than remaining in isolation with the computer, accessing information and possibly missing a sentinel ingredient that would enhance patient care and ultimately safety and outcomes.
Paula Dunn Tropello, EdD, FNP-BC, dean of the Evelyn L. Spiro School of Nursing at Wagner College in Staten Island, N.Y., specializes in global and disaster nursing.