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


BACKGROUND
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.
Williams
Reed G
RG
Southern Illinois University School of Medicine, Springfield, IL, USA. rwilliams@siumed.edu
Silverman
Ross
R
Schwind
Cathy
C
Fortune
John B
JB
Sutyak
John
J
Horvath
Karen D
KD
Van Eaton
Erik G
EG
Azzie
Georges
G
Potts
John R
JR
Boehler
Margaret
M
Dunnington
Gary L
GL
D019058:Community Networks / Q000458:organization & administration*; D013502:General Surgery / Q000458:organization & administration*; D006782:Hospitals, Special / Q000592:standards*; D006801:Humans; D019451:Information Management / Q000379:methods*; D007297:Inpatients; D011785:Quality Assurance, Health Care