title: A policy-based intervention for the reduction of communication breakdowns in inpatient surgical care: results from a Harvard surgical safety collaborative.
abstract: OBJECTIVE
  To develop and evaluate an intervention to reduce breakdowns in communication during inpatient surgical care.
  
  
  BACKGROUND
  Communication breakdowns are the second most common cause of avoidable surgical adverse events after technical errors.
  
  
  METHODS
  In a pre- and postintervention study, a random selection of patients on the surgical services of 4 teaching hospitals were observed according to 3 measures: (1) resident-attending communication of critical patient events (eg, transfer into the intensive care unit, unplanned intubation, cardiac arrest); (2) resident-attending notification regarding routine weekend patient status; and (3) frequency of weekend patient visits by an attending. All departments then developed and adopted a set of policy and education initiatives designed to increase prompt and consistent resident-attending communication (especially in critical events) and to improve regular attending visits with surgical patients. Specific reinforcement of the policies included a pocket information card for residents, as well as periodic reminders. Repeat audits of the surgical services were then conducted.
  
  
  RESULTS
  We reviewed information for 211 critical events and 1360 patients for the nature of resident and attending communication practices. After the intervention, the proportion of critical events not conveyed to an attending decreased from 33% (26/80) to 2% (1/47), and gaps in the frequency of attending notification of patient status on weekends were virtually eliminated (P < 0.0001); the proportion of weekend patients not visited by an attending for greater than 24 hours decreased by half (from 61% to 33%; P = 0.0002). Contact resulted in attending-led changes in patient management in one-third of cases.
  
  
  CONCLUSIONS
  An intervention to improve surgical communication practices at 4 teaching hospitals led to significant reductions in potentially harmful communication breakdowns during inpatient care; significant alterations in patient management were noted in one-third of cases in which there was an adherence to recommended communication practices.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, USA. aarriaga@partners.org
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Arriaga
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Elbardissi
authors.forename: Scott E
authors.initials: SE
authors.lastname: Regenbogen
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.forename: William R
authors.initials: WR
authors.lastname: Berry
authors.forename: Stuart
authors.initials: S
authors.lastname: Lipsitz
authors.forename: Donald
authors.initials: D
authors.lastname: Moorman
authors.forename: James
authors.initials: J
authors.lastname: Kasser
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zinner
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
mesh_terms: D000046:Academic Medical Centers; D001900:Boston; D003422:Critical Care / Q000458:organization & administration; D005260:Female; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D033183:Interdisciplinary Communication; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration; D011050:Policy Making; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D011787:Quality of Health Care; D017751:Safety Management / Q000458:organization & administration* / Q000592:standards; D013514:Surgical Procedures, Operative / Q000592:standards