Failures in communication through documents and documentation across the perioperative pathway.
OBJECTIVE
To explore how communication failures occur in documents and documentations across the perioperative pathway in nurses' interactions with other nurses, surgeons and anaesthetists.


BACKGROUND
Documents and documentation are used to communicate vital patient and procedural information among nurses, and in nurses' interactions with surgeons and anaesthetists, across the perioperative pathway. Previous research indicates that communication failure regularly occurs in the perioperative setting.


METHODS
A qualitative study was undertaken.


METHODS
The study was conducted over three hospitals in Melbourne, Australia. One hundred and twenty-five healthcare professionals from the disciplines of surgery, anaesthesia and nursing participated in the study. Data collection commenced in January 2010 and concluded in October 2010. Data were generated through 350 hours of observation, two focus groups and 20 semi-structured interviews. A detailed thematic analysis was undertaken.


RESULTS
Communication failure occurred owing to a reliance on documents and documentation to transfer information at patient transition points, poor quality documents and documentation, and problematic access to information. Institutional ruling practices of professional practice, efficiency and productivity, and fiscal constraint dominated the coordination of nurses', surgeons' and anaesthetists' communication through documents and documentation. These governing practices configured communication to be incongruous with reliably meeting safety and quality objectives.


CONCLUSIONS
Communication failure occurred because important information was sometimes buried in documents, insufficient, inaccurate, out-of-date or not verbally reinforced. Furthermore, busy nurses were not always able to access information they required in a timely manner. Patient safety was affected, which led to delays in treatment and at times inadequate care.


CONCLUSIONS
Organisational support needs to be provided to nurses, surgeons and anaesthetists so they have sufficient time to complete, locate, and read documents and documentation. Infrastructure supporting communication technologies should be implemented to enable the rapid retrieval, entry, and dispersion of information.
Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic., Australia.
Sandra
S
Braaf
Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic., Australia.
Robin
R
Riley
School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia.|Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia.
Elizabeth
E
Manias
D000328:Adult; D000776:Anesthesiology; D001291:Attitude of Health Personnel; D001315:Australia; D003142:Communication; D004282:Documentation; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D019990:Perioperative Care; D036301:Qualitative Research
communication; communication failure; documentation; healthcare quality; perioperative