title: Interprofessional Communication Patterns During Patient Discharges: A Social Network Analysis.
abstract: BACKGROUND
  Optimal care delivery requires timely, efficient, and accurate communication among numerous providers and their patients, especially during hospital discharge. Little is known about communication patterns during this process.
  
  
  OBJECTIVE
  Our aim was to assess the frequency and patterns of communication between patients and providers during patient discharges from a hospital-based medicine unit.
  On the day of the patient's discharge, the patient and all healthcare providers involved in the discharge were interviewed using structured questions related to information exchange during the discharge process. Each interview identified the frequency and method of communication between participants, including synchronous (e.g., face-to-face) and asynchronous (e.g., through electronic medical record) routes. Communication patterns were visually diagramed using social network analysis.
  
  
  METHODS
  Forty-six patients were screened for inclusion in the network analysis. Of those, seven patients who were fully oriented and able to complete an interview and all providers who participated in their care during the discharge were selected for inclusion in the analysis. In all, 72 healthcare professionals contributing to the discharge process were interviewed, including physicians, nurses, therapists, pharmacists, care coordinators, social workers, and nutritionists.
  
  
  RESULTS
  Patients' mean age was 63, length-of-stay was 7.8 days, and most (86 %) were discharged to home. On average, 11 roles were involved with each discharge. The majority of communication was synchronous (562 events vs. 469 asynchronous events, p = 0.004). Most communication events occurred between the primary nurse and patient and the care coordinator and primary nurse (mean 3.9 and 2.3 events/discharge, respectively). Participants identified intern physicians as most important in the discharge process, followed by primary nurses and care coordinators.
  
  
  CONCLUSIONS
  In patients being discharged from the medicine service, communication was more frequently synchronous, and occurred between intern physicians, primary nurses, and patients. Potential improvements in coordinating patients' discharges are possible by reorganizing systems to optimize efficient communication.
authors.affiliation: Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Pinelli
authors.forename: Klara K
authors.initials: KK
authors.lastname: Papp
authors.forename: Jed D
authors.initials: JD
authors.lastname: Gonzalo
mesh_terms: D005260:Female; D006785:Hospitals, University; D006801:Humans; D033183:Interdisciplinary Communication; D007388:Internal Medicine; D007407:Interviews as Topic; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010351:Patient Discharge; D012944:Social Support