When It Comes to Transitions in Patient Care, Effective Communication Can Make All the Difference

Article excerpt

Poor communication between healthcare providers can lead to dangerous, even life-threatening, situations for patients.

When confronting a health crisis, most patients and their caregivers assume that doctors, nurses, and other healthcare providers communicate with one another. But it's often poor communication, coupled with an expectation that patients or caregivers will remember and relate critical information, which can lead to dangerous, even life-threatening, situations. This plays out most dramatically during care transitions, when a patient leaves one care setting or practitioner to move to another.

Care transitions, according to Dr. Eric A. Coleman (see Coleman's website at www. caretransitions.org/definitions. asp for an excellent definition of care transitions), happen at every stage of the healthcare continuum-within settings, between settings, and across healthcare states. Transitions can include moving from emergency room to surgery, from surgery to the intensive care unit, from hospital to home, and from home to assisted living and back to the hospital. And they often involve many people-the patient and their caregiver, physicians, nurses, social workers, case managers, pharmacists, and other providers.

Effective communication and cooperation between professionals, patients, and caregivers is essential during transitions. Poor communication can endanger patients' lives and waste fiscal and human resources (National Transitions of Care Coalition, 2008); and the fragmentation of the healthcare system at large- with its lack of consistent forms and workflows, lack of accountability for transitions, and lack of performance measures and appropriate alignment of incentives-adds up to a perilous mix for patients.

The more medically complex the patient, the more likely they will experience multiple transitions. Individuals with chronic conditions may see up to sixteen physicians in one year (Bodenheimer, 2008). Elders have a greater likelihood of risk associated with transitions, because they face significant challenges when moving between care settings. Elders may experience cognitive impairment and may not have the health literacy skills to adequately function in the healthcare environment. One study measuring patients' functional health literacy at a public hospital found 81 percent of English-speaking patients ages 60 years or older had inadequate health literacy (Gazmararian et al., 1999). If English is not an elder patient's primary language, there are added risks of poor communication and inability to self-manage their care.

Troubles with Transitions

Patients often assume transitions are carefully planned, with information shared. But research has shown that communication between settings or providers is often limited, or may not occur at all. The lack of timely communication can lead to medical errors, miscommunication between providers and patients, patient safety issues, lack of provider follow up, and hospital readmissions. Each transition requires engagement with the patient and caregiver, information exchange between providers to ensure consistency of treatment, appropriate coordination of care options, and a reconciliation of medications (National Transitions of Care Coalition, 2010).

Transitions also stress patients. Frequently, patients experience anxiety and grow concerned about their ability to manage at home, and the impact not managing will have on their family or caregiver. But these same patients and caregivers find it difficult to address such concerns with physicians or other clinicians. They struggle with what questions to ask and what information to gather. Ultimately, patients and caregivers need to be equipped with the necessary information to understand the discharge care plan, including medication reconciliation and management. Patients and caregivers need to be empowered to manage their own care plan, whether at home or at the next level of care. …