The Case Of Communication Error In Healthcare

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INTRODUCTION

Communication is the process of sharing information, opinions, or facts by speech or writing from one person to another. Good communication can reduce anxiety and build confidence, an effective exchange between people helps them see what the other person thinks and feels, and forms the basis of interaction. Communication in healthcare is one of the most important tools for providing great care and improving patient satisfaction.

Good and effective communication is an indispensable component of quality health care. There is a strong association between the communication skills of healthcare providers and patient health outcomes. The view case is about poor communication in an inter-disciplinary team which resulted in an adverse event for the patient as described in the event below.

THE EVENT

The ultrasound department in Trust A received a request for a renal ultrasound scan (US) for an adult male from his general practitioner (GP). The booking office sent out a letter by post notifying the patient of his examination date and time with relevant instructions. On the exam day, the patient reports for his renal US appointment on time and sat at reception waiting to be called for his US. After about 5 minutes, the Sonographer calls him in for his scan, and within seconds of arriving in the scan room, the patient unintentionally voids on himself. This makes him feel embarrassed, unhappy, and agitated.

The Sonographer was empathic and allowed the patient time to pull together. The patient then explained to the Sonographer that he suffers from urinary incontinence (overactive bladder) and his GP was well aware so he was hoping the GP will notify the department to get his examination done upon arrival. The Sonographer apologized for the communication error and explained to the patient that the information was not transmitted to the ultrasound department, and assured the patient that the US can be done with the residual urine. The patient was glad and was very satisfied with the Sonographers’ conduct before, during, and after the scan and as a result, the patient did not put in a formal complaint.

Discussion

The ultrasound department of Trust A has a local guideline that includes preparations for ultrasound examinations. Usually, an information leaflet is sent to the patient by post indicating an appointment time and date as well as required preparation for the examination this was done in the case in view. The preparation for renal scans requires the intake of 1 liter of water an hour before the appointment time this is to allow for a full bladder which will aid the visualization of the pelvic structures by casting posterior enhancement.

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Request for ultrasound examinations are vetted by Sonographers before appointments are made as per British Medical Ultrasound Society (BMUS) guidelines 2019, this is to allow for proper assessment and justification of the clinical information. Additionally, Necas (2018) posited that Sonographers can assess and evaluate patient information including medical records in the best interest of improving patient outcomes. The vetting was duly done in this case by the ultrasound department before the request was sent out, however, the GP did not include full details of the patient’s condition.

Generally, patients with overactive bladder appear socially withdrawn and distressed, a proactive and enabling environment is essential when caring for such patients. According to Jackson et al., 2017, there is a need for information transfer and continuity as it plays an essential role in patient management. There was an inter-disciplinary communication error between the GP and the ultrasound department in the event above, this led to an avoidable adverse event on a patient. The patient suffered from a pre-existing medical condition of overactive bladder which was known by the referring GP but was not communicated to the ultrasound department in writing as part of the clinical information of the patient, the effect of which includes a psychological impact on the patient and palpable agitation.

The Sonographer on the other hand lost ample time waiting to sort the situation and trying to make sure the patient is given all the support needed at the time. This also led to increasing in waiting time for other patients as the Sonographers list was delayed.

More so, the Sonographer spent more time afterward filling out an incident form. This is necessary to ensure proper documentation of the incident and also support learning from the communication error as well as ensure proper action is taken to keep patients safe.

The incident would have resulted in a more formal complaint save for the excellent approach of the Sonographer who was very polite, involved the patient in the decision to continue the examination, and ensured privacy as well as preservation of patient dignity, the patient was also assured that everything would be kept in strict confidence which is in line with the authors Trust guidelines.

A complaint is an expression of displeasure about an act, oversight, or choice either written or verbal and whether justified or not, which requires a response. The Sonographers actions and explanations on how the referral process works made the patient not lodge an official complaint in this case. Also, the sonographer apologized for the communication error and promised to follow up on the issue. This is important as the sonographer is legally bound by the duty of candor to be open and honest with patients when something goes wrong with their care. The empathic demeanor of the Sonographer ensued calm and satisfaction for the patient.

RECOMMENDATIONS FOR PRACTICE

Given the adverse event, the GP practice needs to be notified of the poor communication and the associated impact on patient care to foster adequate information sharing for effective patient management. Appointment notification emails for ultrasound examination should include messages for patients with special needs to declare such essentials upon arrival for their ultrasound examination to a member of staff for prompt follow-up. The provision of containments, asking the patient at the reception when the patient arrives if they have specific needs and toilet access with visible signs is recommended. This will go a long way to avert any future occurrence.

CONCLUSION

Communication is the cornerstone of healthcare. Effective communication is critical to meeting patient needs and providing timely, safe, patient-centered and high-quality care. The impact of poor inter-disciplinary communication on patient care and management is far-reaching. There is utmost need at all times for solid inter-disciplinary team collaboration and communication in healthcare which emphasizes the accuracy and quality of information shared to avoid the cascade of complications along the patient care pathway. This event has shown that a Sonographer with a good demeanor can improve patient experience during ultrasound examinations. 

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