Learning Objective #1: Understand the role of clinical miscommunication in medical errors and patient harm

Learning Objective #2: Identify practical strategies to enhance nurse-physician communication

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The Institute of Medicine published To Err Is Human in 1999. The report gained national headlines citing evidence that up to 98,000 Americans die annually as a result of medical errors. Crossing the Quality Chasm was published fifteen months later calling the nation to action while setting forth an agenda to improve health care performance. Both reports highlight poor clinical communication among providers as a major cause of inadvertent patient harm. Additionally, according to the Joint Commission on Accreditation of Health Care Organizations, communication failure has been implicated in nearly two thirds of the sentinel events reported to them since 1995. Interestingly, few systematic efforts have been applied to improve this area.

The neonatal intensive care unit (NICU) at The Children's Hospital of Philadelphia instituted a program to improve patient safety by building more effective communication between nurses and physicians. This pilot project was launched with a unit-wide baseline teamwork and safety culture survey, followed by “finding-your-voice” coaching sessions for nurses and utilization of a standardized clinical communication tool known as SBAR (situation-background-assessment-recommendation/request).

More than 60% of eligible participants responded to the survey and included nursing, neonatology and surgery. Over half indicated a positive climate. Low scoring questions pertained to problem resolution, inability to express disagreement and learning from errors. Sixty members of the nursing staff were selected to participate in “finding-your-voice” coaching sessions. These consisted primarily of role-play around difficult clinical scenarios. Participation was followed by individual action plans for increasing self-knowledge and self-awareness and selection of a “buddy” for feedback and support. Session evaluations were overwhelming positive. The SBAR tool provides a mechanism for clear, concise communication.

Ensuring successful nurse-physician communication is critical for the safe patient care. This project outlines a multi-faceted, practical approach that we plan to replicate and spread to other areas of our organization.