Surgeon information transfer and communication: Factors affecting quality and efficiency of inpatient care

Reed G. Williams, Ross Silverman, Cathy Schwind, John B. Fortune, John Sutyak, Karen D. Horvath, Erik G. Van Eaton, Georges Azzie, John R. Potts, Margaret Boehler, Gary L. Dunnington

Research output: Contribution to journalArticle

130 Scopus citations

Abstract

OBJECTIVE: To determine the nature of surgeon information transfer and communication (ITC) errors that lead to adverse events and near misses. To recommend strategies for minimizing or preventing these errors. SUMMARY BACKGROUND DATA: Surgical hospital practice is changing from a single provider to a team-based approach. This has put a premium on effective ITC. The Information Transfer and Communication Practices (ITCP) Project is a multi-institutional effort to: 1) better understand surgeon ITCP and their patient care consequences, 2) determine what has been done to improve ITCP in other professions, and 3) recommend ways to improve these practices among surgeons. METHODS: Separate, semi-structured focus group sessions were conducted with surgical residents (n = 59), general surgery attending physicians (n = 36), and surgical nurses (n = 42) at 5 medical centers. Case descriptions and general comments were classified by the nature of ITC lapses and their effects on patients and medical care. Information learned was combined with a review of ITC strategies in other professions to develop principles and guidelines for re-engineering surgeon ITCP. RESULTS: A total of 328 case descriptions and general comments were obtained and classified. Incidents fell into 4 areas: blurred boundaries of responsibility (87 reports), decreased surgeon familiarity with patients (123 reports), diversion of surgeon attention (31 reports), and distorted or inhibited communication (67 reports). Results were subdivided into 30 contributing factors (eg, shift change, location change, number of providers). Consequences of ITC lapses included delays in patient care (77% of cases), wasted surgeon/staff time (48%), and serious adverse patient consequences (31%). Twelve principles and 5 institutional habit changes are recommended to guide ITCP re-engineering. CONCLUSIONS: Surgeon communication lapses are significant contributors to adverse patient consequences, and provider inefficiency. Re-engineering ITCP will require significant cultural changes.

Original languageEnglish (US)
Pages (from-to)159-169
Number of pages11
JournalAnnals of surgery
Volume245
Issue number2
DOIs
StatePublished - Feb 1 2007
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Williams, R. G., Silverman, R., Schwind, C., Fortune, J. B., Sutyak, J., Horvath, K. D., Van Eaton, E. G., Azzie, G., Potts, J. R., Boehler, M., & Dunnington, G. L. (2007). Surgeon information transfer and communication: Factors affecting quality and efficiency of inpatient care. Annals of surgery, 245(2), 159-169. https://doi.org/10.1097/01.sla.0000242709.28760.56