Jul 06, · Methods. A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (Me SH)terms ‘communication’, ‘primary health care’, ‘correspondence’, ‘patient safety’, ‘patient handoff’ and ‘continuity of patient care’.Reviewers screened records and full texts were checked according following inclusion criteria: (1 Dissertation On Good Quality Communication In Healthcare, Communal Harmony Essay In Hindi, Gre Argument Essay 7 Megalopolis, Ready Freddy Homework Hassles Quiz Dissertation On Good Quality Communication In Healthcare, Ocr As Biology Coursework Help, Cambridge Mphil Public Health Lent Essay, Learn How To Write A Video Essay On Film 11 Sep Topic title: "Homework "
Communication in healthcare: a narrative review of the literature and practical recommendations
Try out PMC Labs and tell us what you think. Learn More. Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare.
A total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences.
There is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver.
In the evolution of medicine, an increasing number of patients, in particular with chronic disease or illness, is requiring treatment by healthcare providers from different disciplines 1. Two major trends emerge. First, diagnostic workups and treatments are increasingly organised on an outpatient basis, and, second, especially treatment and care is shifting towards primary care.
Both trends increase the need for sharing information between specialists and general practitioners GPs to ensure continuity of care, in an integrated transmural model 2345. The practice and delivery of healthcare is argued to be fundamentally and critically dependent on effective and efficient communication 6. This is especially true for countries such as the UK, Denmark and the Netherlands, where GPs act as obligatory gatekeepers and the communication towards and from secondary care determines the smooth running of the healthcare system 7.
However, countries or healthcare systems without this obligatory gatekeeper function may be at higher risk for suboptimal communication between levels of care. The aim of the present paper is to review the existing literature on quality, efficacy and impact of written communication in healthcare as well as of recommendations for improvement. The MeSH terms were internally validated by the coauthors. Database screening was closed 31 March Titles and abstracts were reviewed to verify these criteria.
If all inclusion requirements were present or if this remained unclear, the articles were fully read. In case dissertation on good quality communication in healthcare full text revealed that not all requirements were present, the paper was excluded. Additional literature was obtained through searching references in the manuscripts snowball method. A framework with four categories was predefined: modalities of communication, deficits in communication, economic impact of communication inefficiencies and recommendations.
An individual paper could be categorised into different fields. The review was further elaborated by addressing each category separately and rereading all articles that were relevant for that category. The results of the search process are summarised in Figure 1. Out of a total of papers selected, duplicates were removed. Finally, 69 articles were included in the review. The aim, setting, sample description, design, coverage of categories addressed within the review and main findings of these individual studies are summarised in the online supplement.
Review stages based on PRISMA flow diagram 8. These dissertation on good quality communication in healthcare of direct communication may in fact have decreased in the electronic communication age, favoring indirect rather than direct communication Written communication in the larger interpretation remains the most usual, and sometimes the only, means of communication between healthcare professionals 3.
Dissertation on good quality communication in healthcare most frequently used forms of written communication are referral and discharge letters. Referral letters can be subdivided into three types: i. requests for a specific assessment or treatment, request for a second opinion and requests for mutual responsibility for the care of a patient Discharge letters on the other hand generally refer to patients discharged from hospital.
However, the term is also used for other settings such as answer letters after a specialist outpatient visit without hospitalisation. This in itself poses a problem of semantics and definitions, as the terminology of discharge letters seems not to have followed the shift towards mainly outpatient care.
Written communication certainly has its advantages. For instance, it can be used for future reference purposes and it can be easily and simultaneously distributed to the required number of caregivers involved in the care process Moreover, in the current electronic environment, written communication has evolved towards a more immediate medium and may therefore be preferred Letters also have an educational goal. They can provide extra information that can increase the understanding of the problem, its implications, the problems, and options in management or the prognosis expected There is a large body of literature on inefficiencies in written communication.
Reviews align with these findings. This overall agreement enables drawing conclusions for clinical practice. In this section, on the one hand reports on subjective views of GPs and specialists setting out what they think letters should contain, and on the other hand reports with empirical data on the analysis of the content of actual letters are included General practitioners and specialists disagree about the quality of their mutual communication, dissertation on good quality communication in healthcare.
Furthermore, they feel that GPs insufficiently follow their specialist advice. GPs in turn mention that many of their questions are insufficiently addressed by the specialists. This study showed that GPs telephone accessibility is qualified as poor by specialists Merely half of GPs feels their questions are addressed appropriately by the specialist, whereas specialists feel this number to be considerably higher.
According to specialists, dissertation on good quality communication in healthcare, GPs often do not follow the advice given. GPs rate their compliance much higher. Less than a quarter of GPs feel specialist letters arrive on time, whereas specialists have a different perception, dissertation on good quality communication in healthcare. Both parties wish to receive feedback from each other, while in practice they hardly do so In a study from a single general hospital in Norway assessing referral and discharge letters, the Delphi technique was used by two expert panels each with one general hospital specialist, one GP and one public health nurse using a standardised evaluation protocol with a visual analogue scale The panels assessed the quality of the description of the patient's actual medical condition, former medical history, clinical signs, medication, activity of daily living ADLsocial network, need of home care and the benefit of general hospital care.
This analysis revealed low consensus between health professionals at primary and secondary level and low quality of a majority of referral letters, considered as a health hazard. Expectations on the modalities and content issues of communication may differ according to phases in particular diseases. In the modern relational personalistic ethical perspective, the patient viewpoint and experience of the collaboration between GP and specialists is at least as important as the perception of the healthcare professionals.
To this purpose, a consumer quality index continuum of care has been validated for assessing patient's experiences across the interface between primary and secondary care. More than 20 years ago, Newton et al. questioned GPs and specialists on which items they considered important, revealing a high degree of consensus They also reported what the Dissertation on good quality communication in healthcare expects from the referral. These expectations are also described in Tattersall et al.
A number of items are summarised in Table 2. Hartveit et al. aimed at identifying the recommended content of referral letters from GPs to specialised mental healthcare by means of discussion groups.
Seven headings were proposed: personal and contact information, introductory information e. is the patient suicidal?
More specifically, as compared with other referral letters, in mental healthcare a stronger emphasis on the planned integrated care, the specialist's role and on the patient's involvement is recommended Jiwa et al. Furthermore, GP referral letters do not always include a specific question and when a question is formulated, it is not always addressed. This disables a real information exchange McConnell et al. performed an information audit of referral and reply letters in cancer care.
Oncologists wanted to have more information about the patient's medical status, the involvement of other doctors and any special considerations, dissertation on good quality communication in healthcare.
GPs preferred more information about the treatment plan, future management and expectations and psychosocial concerns. Referral letters about older patients were of low quality and only the actual medical situation was well described. A review by Kripalani et al. Tattersall et al. compared the content of letters to the patients and letters to the referring physician. Durbin et al. The readability level of letters was another issue raised. Letters of specialists would be too detailed and not enough structured e.
lacking headings, long paragraphs 30 Reasons for the poor content of written communication are also multifactorial: a lack of time to create notes 10GPs maybe do not make a full assessment of the problems 24dissertation on good quality communication in healthcare, GPs and specialists may use a different point of view 19they may consider letters to have different goals e, dissertation on good quality communication in healthcare.
a tool for information transfer vs. archiving 17etc. A considerable number of studies assessed timeliness of communication, either the subjective perception or real delays. It is clear that timeliness is a significant contributor to communication efficiency for all stakeholders. Besides the unsatisfactory content of written communication, timeliness is another frequently reported problem. This delay can have multiple causes and occurs at different stages of the reporting process: the specialist can wait too long to draw up the letter whether dictated or extracted form an electronic patient record ; the administrative workup e.
typing the letter and verification finalised by signature can add significantly to the final delay This could explain the perceptions of GPs and specialists about timeliness. Inefficient communication has several potentially negative consequences, for all involved in the healthcare process.
Effective Communication in Healthcare Organizations
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