Perspectives on communication in labor and delivery: a focus group analysis.

OBJECTIVE: The objective of this study was to elicit and explore perceptions of barriers to optimal communication among clinicians on a labor and delivery unit, and to use this information to select and design approaches to improve communication. STUDY DESIGN: A qualitative research design using a focus group format was utilized. Attending and resident obstetricians and anesthesiologists, as well as staff nurses, pharmacists and unit secretaries participated in the focus groups, which were recorded and transcribed. Data were analyzed using a framework analysis approach. RESULT: In total, 18 focus groups with a total of 92 participants were conducted. Eight key themes emerged regarding specific barriers to effective communication among clinicians in the labor and delivery setting. The most prominent of these themes included issues with inter-departmental coordination, clinical accessibility (the ability to reach other clinicians), lack of a consistent approach for clinical documentation, and the involvement of multiple care providers. On the basis of these themes, multiple interventions were designed to enhance communication. CONCLUSION: Focus group methodology can be used to elicit a detailed description of communication practices of clinicians on a labor and delivery unit, permitting an exploration of specific barriers to communication and the identification of potential solutions to those barriers.

Teamwork on inpatient medical units: assessing attitudes and barriers.

BACKGROUND: Discrepant attitudes about teamwork among nurses and physicians exist in operating rooms and intensive care units. Little is known about teamwork attitudes on general medical services. OBJECTIVE: To assess ratings of teamwork by providers on inpatient medical units and barriers to collaboration. DESIGN AND PARTICIPANTS: Nurses, primary hospital physicians and medical subspeciality consultants on four general medical units were surveyed. MEASUREMENTS: Providers rated the quality of communication and collaboration experienced with their own and other disciplines. Providers also rated potential barriers to collaboration. Differences between providers in ratings of collaboration and barriers were tested using analysis of variance. RESULTS: Of 230 eligible providers, 159 (69%) completed the survey. Teamwork ratings of nurses were similarly high across provider types. Ratings of physicians differed considerably by provider type (p

Active surveillance using electronic triggers to detect adverse events in hospitalized patients.

BACKGROUND: Adverse events (AEs) occur with alarming frequency in health care and can have a significant impact on both patients and caregivers. There is a pressing need to understand better the frequency, nature, and etiology of AEs, but currently available methodologies to identify AEs have significant limitations. We hypothesized that it would be possible to design a method to conduct real time active surveillance and conducted a pilot study to identify adverse events and medical errors. METHODS: Records were selected based on 21 electronically obtained triggers, including abnormal laboratory values and high risk and antidote medications. Triggers were chosen based on their expected potential to signal AEs occurring during hospital admissions. Each AE was rated for preventability and severity and categorized by type of event. Reviews were performed by an interdisciplinary patient safety team. RESULTS: Over a 3 month period 327 medical records were reviewed; at least one AE or medical error was identified in 243 (74%). There were 163 preventable AEs (events in which there was a medical error that resulted in patient harm) and 138 medical errors that did not lead to patient harm. Interventions to prevent or ameliorate harm were made following review of the medical records of 47 patients. CONCLUSIONS: This methodology of active surveillance allows for the identification and assessment of adverse events among hospitalized patients. It provides a unique opportunity to review events at or near the time of their occurrence and to intervene and prevent harm.