title: Critical conversations: a call for a nonprocedural "time out".
abstract: BACKGROUND
  Communication failures are an ongoing threat to patient safety. Procedural "time outs" were developed as a method to enhance communication and mitigate patient harm. Nonprocedural settings generate equal risks for communication failure, yet lack a similar communication tool or practice that can be applied, particularly with a patient-driven focus.
  
  
  METHODS
  Rapidly changing clinical states and care plans are common in the hospital setting, placing patients at risk for adverse events. Certain junctures allow for the highest potential of patient harm-at the time of admission, at a change in clinical condition, and at the time of discharge. Direct communication among healthcare providers at these junctures, which we have dubbed Critical Conversations, can provide an opportunity to clarify plans of care, address or anticipate concerns, and foster greater teamwork. Information exchanged during Critical Conversations includes a combination of checklist-type items and more open-ended questions but they ultimately create a structure and expectation for communication.
  
  
  CONCLUSIONS
  Integration of Critical Conversations into practice requires provider education and buy-in, as well as expectations for them to occur. Monitoring adherence, capturing stories of success, and demonstrating effectiveness may enhance implementation and continuous improvement in the process.
  
  
  CONCLUSIONS
  Communication tools designed to reduce the likelihood of patient harm remain a focus of patient safety efforts. Critical Conversations are an innovative communication tool, intervention, and policy that potentially limits communication failures at critical junctures to ensure high quality and safe patient care.
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco, San Francisco, California 94143, USA. nirajs@medicine.ucsf.edu
authors.forename: Niraj L
authors.initials: NL
authors.lastname: Sehgal
authors.forename: Michael
authors.initials: M
authors.lastname: Fox
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Sharpe
authors.forename: Arpana R
authors.initials: AR
authors.lastname: Vidyarthi
authors.forename: Mary
authors.initials: M
authors.lastname: Blegen
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wachter
mesh_terms: D003142:Communication; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D010343:Patient Admission / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*; D017751:Safety Management / Q000379:methods / Q000592:standards*