Experts recognize that good communication is important to patient safety and satisfaction.11 Clinicians are constantly juggling multiple moving parts on the medical-surgical floor.12 For example, one surgery patient may see up to 27 different providers during a hospital stay.13
Managing competing priorities on complex care teams can be challenging. Information can get lost and that creates gaps in communication, which can further interrupt or delay workflow, on the general care floor.11 This could waste time and money, but more importantly, these gaps may also negatively affect patient outcomes.14
Here’s the good news. Clinicians are improving communication and bridging gaps every day, with help from smarter workflows and technologies.13 They’re using wireless devices to stay connected while on the go.15 And they’re reducing response times while improving outcomes through more efficient communication.13
Communication challenges can impact the medical-surgical floor. And those challenges may affect care. We have four important ways to help you manage them. Find out how you can help improve communication and patient outcomes on the wards.
Medical-surgical nurses can spend more than one-fifth of their shift coordinating care with team members or other departments.12 And they’ve reported communication gaps as the second-most common cause of operational failures — after equipment problems.9 Such failures can interrupt workflow and consume up to 10 percent of a nurse’s shift.16 Communication gaps can also affect patient safety.10,14
But technology can help you close these communication gaps. Here are four ways using technology on the MedSurg floor to overcome communication challenges.
A review of malpractice claims revealed more than 7,000 cases where communication failures harmed patients — including 1,744 deaths.17 Communication errors are estimated to cost the healthcare industry $17 billion a year.18 One recent study identified poor communication as the primary cause of more than 70 percent of serious medical errors.14 It was also a contributing factor in more than 60 percent of all adverse events in hospitals.19
Untimely transmission of patient information can affect care. Consider the example of a patient being released from the hospital before the completion of medical tests.10 What if the patient was already discharged, but the pending test results were actionable?
Technology can help. For instance, the use of secure text messaging can reduce communication failures by 59 percent.20
And simple care handoff protocols like situation, background, assessment, recommendation (SBAR) can help structure and improve the communication between nurses and physicians.14 After implementing SBAR, studies have shown reductions in hospital mortality, dangerous bacteria, adverse events, and cardiac arrests.19
If a nurse can’t respond quickly when a patient’s call light goes off, patient safety can be compromised.21
Physical distance may also make communication tasks more time-consuming. Nurses walk between one and five miles each 10 hour shift.12 Walking to and from the nurses’ station to answer the phone can take up to 58 minutes of each day.22 And some studies show that nurses spend from 10 to 25 percent of their time in search of other staff.23
Technology can help. Better mobile information systems can help compensate for physical distance.15 For instance, one hospital used direct, bidirectional communication “badges” instead of one-way pager technology in order to get caregivers to a patient’s bedside quicker.24 Caregivers responded more than a minute faster on average. And they were able to address clinical alarms 100 percent of the time, versus 19 percent with pagers.24
In one study, only 40 percent of total nursing activities observed were documented in nursing records.25 Assessments that get manually documented can contain errors.26
Technology can help. Automatically transmitting patient data to electronic health records through integrated monitoring devices27 can help reduce both omissions and transcription errors.27 One study showed that vital signs documented on paper had a 18.75 percent error rate versus a zero percent error rate from the wireless system.27
Wireless monitoring can also save time on charting by improving nursing workflow.28 One study found that implementing an automatic advisory vital sign monitor shortened the time to complete and record a set of vitals by 1.6 minutes.28
Another study found that with wireless monitoring, nurses spent 4.4 percent less time on administrative activities and the need for bedsitters plummeted by 24 percent.22
Integrating monitoring data with wireless tools can help you document and communicate better.
The design of nurses’ stations can affect communication, processes, and outcomes.29 For example, decentralized nursing workstations may help both increase and lengthen visits to patient rooms.30
Technology can help. Today, nurses can document patient assessments directly with handheld devices that transmit data to an electronic record.22
For instance applications providing an early warning score (EWS) can help you quickly assess the severity of a patient's condition. An EWS pulls from physiologic data including blood pressure, heart rate, respiratory rate, and observational data such as level of consciousness.
These handheld devices like these can reduce documentation time by almost 25 percent.22 In one hospital, wireless devices helped nurses reclaim 30 minutes each shift.22
Wireless solutions and mobile technology can also help improve patient safety.21,22,31 They can dramatically reduce response times to alarms — from 9.5 minutes to 39 seconds, in one case22 — and increase response rates.22 Faster call response times can help lower the rate of patient falls, including those leading to injuries.21,31
Wireless technology with early warning scores can help you save time and improve communication. See how.
Melissa Worthington is a Clinical Product Specialist Microstream™ capnography, Nellcor™ pulse oximetry, and Vital Sync™ Remote Monitoring systems at Medtronic US.
†Compared to spot check, manual EWS systems
1. Jones S, Mullally M, Ingleby S, Buist M, Bailey M, Eddleston JM. Bedside electronic capture of clinical observations and automated clinical alerts to improve compliance with an Early Warning Score protocol. Crit Care Resusc. 2011;13(2): 83-88
2. Moon A, Cosgrove JF, Lea D, Fairs A, Cressey DM. An eight year audit before and after the introduction of modified early warning score (MEWS) charts, of patients admitted to a tertiary referral intensive care unit after CPR. Resuscitation. 2011;82(2): 150-154
3. Peris A, Zagli G, Maccarrone N. The use of Modified Early Warning Score may help anesthesists in postoperative level of care selection in emergency abdominal surgery. Minerva Anestesiol. 2012;78(9):1034-1038
4. Bellomo R, Ackerman M, Bailey M, et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012;40:2349-2361.
5. Smith MEB, Chiovaro J, O’Neil M, et al. Early Warning Scoring Systems: A Systematic Review. Washington, DC: Department of Veteran Affairs (US); 2014. https://www.ncbi.nlm.nih.gov/books/NBK259026/. Accessed January 24, 2017.
6. Guarascio-Howard L. Examination of wireless technology to improve nurse communication, response time to bed alarms, and patient safety. HERD. 2011; 4(2):109-120
7. Giuliano, K. Improving patient safety and clinical outcomes through nursing surveillance. Biomedical Instrumentation & Technology: Clinical Alarms: Managing the Overload. 2017;51(s2): 34-43
8. Swartz CH. A systematic approach to manage clinical deterioration on inpatient units in the health system. 2011. DNP Practice Inquiry Projects. http://uknowledge.uky.edu/dnp_etds/26. Accessed March 2017.
9. Stevens KR, Ferrer RL. Real-time reporting of small operational failures in nursing care. Nurs Res Pract. 2016;2016:8416158.
10. Taran S. An examination of the factors contributing to poor communication outside the physician-patient sphere. Mcgill J Med. 2011;13(1):86.
11. Keenan G, Yakel E, Dunn Lopez K, Tschannen D, Ford YB. Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information. J Am Med Inform Assoc. 2013;20(2):245–251.
12. Hendrich A, Chow MP, Skierczynski BA, Lu Z. A 36-hospital time and motion study: how do medical-surgical nurses spend their time? Perm J. 2008;12(3):25–34.
13. Gordon JE, Deland E, Kelly RE. Let’s talk about improving communication in healthcare. Col Med Rev. 2015; 1(1):23–27.
14. Shahid S, Thomas S. Situation, Background, Assessment, Recommendation (SBAR) communication tool for handoff in health care – a narrative review. Safety in Health. 2018; 4:7. doi.org/10.1186/s40886-018-0073-1.
15. Prgomet M, Georgiou A, Westbrook JI. The impact of mobile handheld technology on hospital physicians' work practices and patient care: a systematic review. J Am Med Inform Assoc. 2009;16(6):792–801.
16. Tucker AL, Heisler WS, Janisse LD. Organizational factors that contribute to operational failures in hospitals. Harvard Business School website. https://hbswk.hbs.edu/item/organizational-factors-that-contribute-to-operational-failures-in-hospitals. Oct. 1, 2013.
17. Bailey M. Communication failures linked to 1,744 deaths in five years, US malpractice study finds. STAT website. https://www.statnews.com/2016/02/01/communication-failures-malpractice-study/. Published Feb.1, 2016. Accessed June 14, 2019.
18. Vardaman JM, Cornell P, Gondo MB, Amis JM, Townsend-Gervis M, Thetford C. Beyond communication: the role of standardized protocols in a changing health care environment. Health Care Manage Rev. 2012;37(1):88-97.
19. Müller M, Jürgens J, Redaèlli M, et al. Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ Open. 2018;8:e022202. doi: 10.1136/bmjopen-2018-022202.
20. Hansen JE, Lazow M, Hagedorn PA. Reducing Interdisciplinary Communication Failures Through Secure Text Messaging: A Quality Improvement Project. Pediatr Qual Saf. 2018;3(1):e053. doi: 10.1097/pq9.0000000000000053.
21. Tzeng HM, Titler MG, Ronis DL, Yin CY. The contribution of staff call light response time to fall and injurious fall rates: an exploratory study in four US hospitals using archived hospital data. BMC Health Serv Res. 2012;12:84. doi: 10.1186/1472-6963-12-84.
22. Turisco F, Rhoads J. Equipped for efficiency: Improving nursing care through technology. 2008: California HealthCare Foundation website. https://www.chcf.org/wp-content/uploads/2017/12/PDF-EquippedForEfficiency.pdf. Published Dec. 2008.
23. Tucker AL, Spear SJ. Operational failures and interruptions in hospital nursing. Health Serv Res. 2006;41(3 Pt 1):643–662.
24. Bonzheim KA, Gebara RI, O'Hare BM, et al. Communication strategies and timeliness of response to life critical telemetry alarms. Telemed J E Health. 2011;17(4):241–246.
25. De Marinis MG, Piredda M, Pascarella MC, et al. 'If it is not recorded, it has not been done!'? consistency between nursing records and observed nursing care in an Italian hospital. J Clin Nurs. 2010;19(11–12):1544–1552.
26. Clarke B. The Cost of Manual Charting. Point Care. 2013;12(2):67–68.
27. Fieler VK, Jaglowski T, Richards K. Eliminating errors in vital signs documentation. Comput Inform Nurs. 2013;31(9):422–427; quiz 428-429. doi: 10.1097/01.NCN.0000432125.61526.27.
28. Bellomo R, Ackerman M, Bailey M, et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012;40(8):2349–2361
29. Real K, Bardach SH, Bardach DR. The role of the built environment: How decentralized nurse stations shape communication, patient care processes, and patient outcomes. Health Commun. 2017;32(12):1557–1570.
30. Fay L, Carll-White A, Schadler A, Isaacs KB, Real K. Shifting landscapes: The impact of centralized and decentralized nursing station models on the efficiency of care. HERD. 2017;10(5):80–94.
31. Guarascio-Howard L. Examination of wireless technology to improve nurse communication, response time to bed alarms, and patient safety. HERD. 2011;4(2):109–120.
32. Jones S, Mullally M, Ingleby S, Buist M, Bailey M, Eddleston JM. Bedside electronic capture of clinical observations and automated clinical alerts to improve compliance with an Early Warning Score protocol. Crit Care Resusc. 2011;13(2): 83-88.
33. Moon A, Cosgrove JF, Lea D, Fairs A, Cressey DM. An eight year audit before and after the introduction of modified early warning score (MEWS) charts, of patients admitted to a tertiary referral intensive care unit after CPR. Resuscitation. 2011;82(2): 150-154.
34. Peris A, Zagli G, Maccarrone N. The use of Modified Early Warning Score may help anesthesists in postoperative level of care selection in emergency abdominal surgery. Minerva Anestesiol. 2012;78(9):1034-1038.
35. Smith MEB, Chiovaro J, O’Neil M, et al. Early Warning Scoring Systems: A Systematic Review. Washington, DC: Department of Veteran Affairs (US); 2014. https://www.ncbi.nlm.nih.gov/books/NBK259026/. Accessed January 24, 2017.
36. Swartz CH. A systematic approach to manage clinical deterioration on inpatient units in the health system. 2011. DNP Practice Inquiry Projects. http://uknowledge.uky.edu/dnp_etds/26. Accessed March 2017
37. Giuliano, K. Improving patient safety and clinical outcomes through nursing surveillance. Biomedical Instrumentation & Technology: Clinical Alarms: Managing the Overload. 2017;51(s2): 34-43.