Milisa Manojlovich1, Jessica M Ameling2, Jane Forman2, Samantha Judkins2, Martha Quinn2, Jennifer Meddings2. 1. Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System. mmanojlo@umich.edu. 2. Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System.
Abstract
BACKGROUND: Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians. OBJECTIVES: To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters. METHODS: Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital. Common themes were identified, analyzed, and then organized using a conceptual framework of contextual barriers to communication: organizational, cognitive, and social complexity. RESULTS: Several barriers to communication between physicians and nurses contributed to inappropriate use and delayed removal of catheters. Workflow misalignment between clinicians was a barrier associated with organizational complexity, issues with electronic medical records and pagers were associated with cognitive complexity, and strained relationships between clinicians and rigid hierarchies were associated with social complexity. CONCLUSIONS: Communication is contextual, and improving physician-nurse communication about appropriate catheter use may require innovations that address the identified contextual barriers.
BACKGROUND: Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians. OBJECTIVES: To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters. METHODS: Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital. Common themes were identified, analyzed, and then organized using a conceptual framework of contextual barriers to communication: organizational, cognitive, and social complexity. RESULTS: Several barriers to communication between physicians and nurses contributed to inappropriate use and delayed removal of catheters. Workflow misalignment between clinicians was a barrier associated with organizational complexity, issues with electronic medical records and pagers were associated with cognitive complexity, and strained relationships between clinicians and rigid hierarchies were associated with social complexity. CONCLUSIONS: Communication is contextual, and improving physician-nurse communication about appropriate catheter use may require innovations that address the identified contextual barriers.
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Authors: Martha Quinn; Jessica M Ameling; Jane Forman; Sarah L Krein; Milisa Manojlovich; Karen E Fowler; Elizabeth A King; Jennifer Meddings Journal: Jt Comm J Qual Patient Saf Date: 2019-12-23
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