The challenge of physician-nurse communication

LETTERS TO THE EDITOR

April 2014 Vol 99 No 4

The challenge of physician-nurse communication As a senior director of perioperative services who is concerned with patient outcomes and risk management, I would like to offer a response to the “Perioperative Grand Rounds” column, “Discharge instructions in the PACU: who remembers?” (November 2013, Vol 98, No 5). I am in complete agreement that communication at the time of discharge is essential. In regard to the scenario presented, the recommendation to call soon after discharge to review the instructions is missing a piece of essential collaboration that should not be overlooked. In the scenario, the discharge instructions were generic, except for a small comment. No additional orders came from the surgeon. Communication failure resulted in patient compromise. However, the failure occurred between the surgeon and the nurse. I cannot help but surmise that if the postanesthesia care unit (PACU) nurse had knowledge of updated instructions, then he or she would have intervened and then documented. The immediate postoperative note is also a source of information for the PACU nurse; however, the content of this note was not presented. The surgeon briefed the patient postoperatively and then called her family members. There is no assurance in the scenario that the nurse heard either conversation. The nurse hand-over report may have included the change in the surgical procedure; however, unless the surgeon specified the change in the postoperative instructions, the nurse may not have known about this change. Therefore, the follow-up telephone call to the patient the day after surgery would not have likely revealed missing

discharge instruction orders. It is my opinion that the surgeon perceived that he was effectively communicating; however, he made the error of excluding the nurse. There remain many challenges regarding nursephysician communication. The nurse and the physician have different work perspectives, and, unfortunately, some physicians still see a “nameless nurse” as a tool to get their work done.1 Mazzocco et al2 identified that infrequent use of team-oriented behaviors, such as information sharing, were associated with increased patient mortality and major complications. Nursing has placed great value and attention on communication. Identifying useful front-line strategies for improving physician-team engagement should be on our nursing leadership agenda. I was glad to see that the conclusion of the “Perioperative Grand Rounds” column listed a recommendation for “effective communication among providers” because this may have averted the problem of the missing collaboration. JANET RUSCOE BSN, RN, CCRN SENIOR DIRECTOR OF PERIOPERATIVE SERVICES DIGNITY HEALTH MERCY MERCED MERCED, CA http://dx.doi.org/10.1016/j.aorn.2014.02.006

References 1. Crawford CL, Omery A, Seago JA. The challenges of nurse-physician communication: a review of the evidence. J Nurs Adm. 2012;42(12):548-550. 2. Mazzocco K, Petitti DB, Fong KT, et al. Surgical team behaviors and patient outcomes. Am J Surg. 2009;197(5): 678-685.

Patients are unlikely to use a patient’s checklist I am writing in response to the “Patient Safety First” column, “Putting the patient into patient safety checklists” (October 2013, Vol 98, No 4). The rationale for my response is that I believe

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that patients will not readily use a patient safety checklist. I applaud the authors’ efforts in making the patient safety checklist patient centered in office-based procedures. They refer to this as