Communication Breakdowns Lead to Medical Errors
Communication breakdowns among providers, between patient or family and healthcare professionals, and involving technology, including the Internet, e-mail, telephone, and telemedicine can lead to the failure of critical information getting relayed, resulting in medical errors. Communication is the foundation of good patient-physician relationships and despite efforts to improve safety and reduce the frequency of medical errors, patient harm caused by communication breakdowns remains a significant problem.
Communication failures were linked to 1,744 deaths in five years and 30% of 23,568 cases of medical malpractice filed from 2002 to 2013 indicated communication as a factor. About 44% of communication breakdowns happened in hospital inpatient environments, 48% in ambulatory settings, and 8% in emergency departments.
Forms of Communication Breakdowns in Healthcare Settings
One study found that the dominant theme was a breakdown in the patient-physician relationship, often manifested as failed or insufficient patient-physician communication. Perceived communication problems included physicians attempting to mislead patients, not talking openly, or failing to warn patients of long-term problems. Other communication problems included perceptions that doctors devalued patient or family views, failed to understand the patient’s perspective, delivered information poorly, or were otherwise unavailable.
Patients should be educated about their diagnosis, treatment and medication options, be allowed follow-up appointments and should have access to physicians if something arises. Communication failures among providers may be attributed to failure to establish clear lines of responsibility, information lost in the transition of care, or ineffective closed-loop communication. Failure to read or update a patient’s medical record may severely impact the ability to deliver appropriate care. In one case, a surgeon and anesthesiologist failed to communicate regarding oxygen and electrocautery use in the surgery room and this resulted in a patient sustaining extensive facial burns.
The use of electronic systems may reduce patient-doctor face-to-face time and when the technology fails, huge amounts of information may be lost. EHR failures have been linked to failed communication and many medical errors. A recent study found that an erroneous software configuration at a facility prevented the transmission of over a quarter of positive fecal occult blood tests over the system. This may lead to providers missing critical information within the huge amount of data. Errors leading to a patient injury can be reduced by identifying and eliminating the most frequent communication breakdowns.