Communication loads on medical staff may lead to error
Communication overloads on clinical staff in acute clinical environments are a likely cause of systematic error in the health system, according to a study in the latest issue of the Medical Journal of Australia.
A team of researchers led by Enrico Coiera, Professor, and Founding Chair in Medical Informatics at the University of New South Wales, compared two emergency departments in New South Wales hospitals, to measure communication loads on clinical staff and the pattern of informal and formal communication events.
Nearly a third of communication events (30 per cent) were identified as interruptions - accounting for over 11 interruptions per hour for all subjects.
In the study, conducted between June and July 1999, patterns of communication were examined by classifying communication events into informal (face-to-face conversation, telephone, pager, letter, whiteboard and email) or formal (patients' medical records, computer information system, test results, forms, medical literature, drug manuals); the purpose of communication (eg, test ordering, results gathering or exchange of information); and by the channel of communication (synchronous or asynchronous).
The study revealed that communication events occupied about 80 per cent of the time clinicians' were observed.
A third of communication events were interruptions and occurred using a synchronous communication channel such as face-to-face or telephone conversations.
"Interruptions are an important measure of communication load because an interruption can disrupt memory and generate errors," says Professor Coiera.
The observational study found that, compared with nursing staff, medical staff had a significantly greater period of multitasking, which may also affect memory.
"The combination of multitasking and interruption may be a potent cocktail and a potential source of error," says Professor Coiera.
Of the patterns of communication examined, face-to-face conversation accounted for 82 per cent. While medical staff asked for information slightly less frequently than nursing staff, they received information much less frequently.
"It is interesting to find out whether the questions asked by doctors are less easily answered, less well articulated, or perhaps less well delivered," said Professor Coiera.
In conclusion, the researchers support the need for communication training in emergency departments and other similar workplaces to reduce error and improve the quality and safety of health care delivery.
An editorial in the same issue of the MJA, by Professor Charles Vincent, University College of London, UK and Professor Robert Wears, University of Florida Health Science Center, USA, supported future studies linking communication to the occurrence of error of clinical performance or outcome.
"Communication problems may take a number of different forms, and it is important to distinguish between them, as both the contribution to error or adverse outcome and appropriate remedy vary considerably," Professor Vincent said.
Depending on the nature of the problem, Professor Vincent said the key intervention may be individual training, or involve technical aids, or be team-oriented.
"Most improvements in communication will require a change in human behaviour," Professor Vincent said.
In concluding, Professor Vincent said that while communication overloads may well lead to errors, this is yet to be firmly established, and emphasised the urgent need for further studies to determine the real impact of the communication loads on the quality and safety of medical care.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: Professor Enrico Coiera
- (02) 9385 3970 (B/H)
(02) 9389 5894 (A/H)
(0405) 302 005 (weekend contact)
- (02) 9385 3970 (B/H)
Professor Charles Vincent
- (0011) 44 207 679 5948 (B/H) (< 10 hours AEST)
Email: ucjtscv@ucl.ac.uk
Sarah Crichton, AMA
(0419) 44 0076
- (0011) 44 207 679 5948 (B/H) (< 10 hours AEST)