Communication practices on 4 Harvard surgical services: a surgical safety collaborative

Area of Science:

• Medical Education
• Patient Safety
• Surgical Communication

Background:

• Communication breakdowns between surgical residents and attending physicians are a common cause of patient injury.
• Understanding the frequency of resident-attending communication failures and attending physician involvement is crucial for improving patient safety.
• A prospective study was conducted across four Harvard teaching hospitals to investigate these communication dynamics.

Purpose of the Study:

• To determine the frequency of communication failures between surgical residents and attending physicians.
• To assess the extent of attending physician involvement in patient care decisions.
• To evaluate how often attending physician input alters the management plan for surgical patients.

Main Methods:

• Employed three prospective data collection strategies: resident surveys on critical events and communication, patient interviews and chart reviews on weekends, and senior resident queries on attending-resident discussions.
• Randomly selected surgical services and patients for data collection to ensure representative sampling.
• Focused on critical patient events and routine weekend care to capture diverse communication scenarios.

Main Results:

• 33% of critical patient events were not communicated to attending surgeons.
• Attending physicians were receptive to communication, but residents perceived involvement as unnecessary in 76% of events.
• Attending involvement, though infrequent (42% visitation on weekends), led to management modifications 46% of the time.

Conclusions:

• Surgical residents frequently fail to seek attending physician input for management decisions, driven by perceived necessity rather than attending unresponsiveness.
• Attending physicians' involvement significantly impacts patient care plans, indicating substantial potential for communication improvement.
• Addressing these communication gaps is essential to reduce information loss and enhance patient safety in teaching hospitals.