the name and title of the person who
received the information, the time the
contact was initiated, and the response
time.
The common theme underlying
these patient safety goals is the need to
provide reliable information in an effort
to prevent patient harm. Standardized
communication processes have gained
widespread acceptance in the health
care industry as a way to address this
theme.11
One model of a standardized process
for use in communications between
doctors and nurses is the SBAR (
situation, background, assessment, and
recommendation) method.12 This unified approach ensures that pertinent
and vital information is not forgotten.
This standardized system is not limited
to routine patient hand-offs. Critical
information pertaining to a change in
the patient’s condition should also be
communicated through a standardized
process.
For example, when communicating a change in a patient’s condition
using the SBAR method, the conversation between a doctor and nurse would
address the following questions:
• What is the current situation? (“The
patient is increasingly short of
breath.”)
• What is the background leading
up to the current situation? (“The
patient has a history of emphysema
and is oxygen-dependent at home.”)
• What is the assessment of the situation? (“The oxygen saturation is 92
percent on two liters of oxygen, the
pulse is rapid at 110, and the capillary refill is sluggish.”)
• What should be done to correct the
problem? (“The patient needs an
immediate breathing treatment.”)
Documentation of this conversation
should be recorded in the patient’s med-
ical record, which also should reflect
the patient’s response to treatment. In
discovery, request not only the hospital’s
policy on using a standardized process
like SBAR, if any, but also the details of
how staff are instructed on the process
and evaluated in their competence in
using it.
Both doctors and nurses have a duty
to report a change in a patient’s condition to each other—even if one or the
other is not present. In Rixey v. West
Paces Ferry Hospital, Inc., a doctor was
found liable for failing to communicate
to the nurses, before leaving the hospital, that a patient’s chest X-ray showed
a build-up of air.13 The court also found
the nurse liable for failing to report the
patient’s deteriorating condition to the
doctor.14
Conduct and Computers
The conduct of medical professionals affects the dynamics of the
communication process, so you will
want to find out whether the doctors
who provided care to your client had a
reputation for intimidating or abusive—
what the AMA calls “disruptive”—
conduct toward nurses.15 Published research
confirms that health care facilities that
foster and support respectful, collegial, patient-centered communication
among doctors and nurses have fewer
medical errors.16
The studies also provide evidence
that abusive and intimidating behaviors
deter collaborative care, impair concentration and focus, and may delay necessary treatment because nurses may wish
to avoid and may hesitate to contact the
disruptive doctor.17 Despite this, hospital administrators have traditionally left
these behaviors unchecked.18
You should suspect that inappropriate behavior may have affected your
Critical information pertaining
to a change in the patient’s
condition should be
communicated through a
standardized process.
