Acute Care and Communication

Ineffective Communication Between Shifts in Acute Care Settings Significant A recent statistics of the adverse effects arisen from ineffective communication between shifts in acute care setting range from 2.6% to 7.6%, however, Okoniewska, et al. (2015) believes that the adverse effects on in-patients can be between 19% and 23%. (Classen, Resar, Griffin. et al. 2011). The Study aims to discuss the adverse effective arisen from ineffective communication between shifts within acute care settings.

Consequences of not solving the problem Without implementing the strategies that can enhance effective communication between shifts in an acute healthcare setting, the issue can lead to mortality, readmission, and post-hospital adverse effects. Moreover, poor communication between shifts can lead to medication problems resulting to therapeutic errors. (Okoniewska, et al. 2015). Moreover, lack of intervention to address the problem can lead to medical errors, which can lead to patients' harms.

Communication failure has also been identified as the root cause of more than 70% of sentinel events, resource use, and the length of patient's stay leading to caregiver dissatisfactions and rapid caregiver turnover. Lack of intervention to address ineffective communication can also jeopardize patients' safety by "increasing tension, increasing cognitive load, and interrupting routine in the healthcare system." (Lingard, 2004 p 330, Dingley, Daugherty, Derieg, et al. 2008). However, King et al. (2013) argue that poor communication between shifts has been identified as the strongest predictor of 30-day re-hospitalization.

Thus, failure to identify and recognize the issues can lead to a cultural clash, blame, and unrealistic expectations. Moreover, inadequate communication discharge can have a negative impact on patients' family and staff in a care setting. Consequently, inaccurate information can produce care delays because of the time-consuming process of recording and gathering information necessary to implement a safe and effective healthcare plan. In the orthopedic devices, ineffective communication can lead to an increased risk for re-hospitalization and mobility issues. (King et al. 2013). C.

Costs of not solving the problem The gravity of the adverse effect from ineffective communication has led to an increase in the estimated total costs of between $17 billion and $19 billion annually. Similarly, the economic burden of ineffective communication in an acute care setting in Canada is $1.1 billion. (Dingley et al. 2008). Moreover, the costs of poor communication were estimated reaching $1.7 billion in malpractice costs leading to the loss of 2,000 lives in 2009. Ritu, Daniel, Diaz et al. (2010) use the economic model to demonstrate the costs of ineffective communication between shift.

The costs include waste in nurse time, physician time and patient length of stay. For example, the costs associated with waste in physician time is estimated reaching $800 million annually. Moreover, communication inefficiencies lead to wastage of more than $4.9 billion annually because of waste in nurse time. Since the demand for nurses professional is more than demand, an unproductive use of nurse' time can further aggravate the resources constraint. Increase the length of stay because of ineffective communication also leads to economic wastage of approximately $6.6 billion annually. II. Background A. Definitions 1.

Conceptual definitions a: Communication: In a healthcare setting, communication is defined as an exchange of information between healthcare professionals to enhance effective diagnosis of patients and delivery of acute care. b: Effective communication: This is a reciprocal and interactive process among healthcare professionals. It involves sender and recipients, which is critical to ensure that message is received and understood. Ability to communicate effectively leads to an accurate diagnosis of patients, which enhance effective acute care delivery.

c: Ineffective Communication: Unfortunately, ineffective communication is the breakdown of communication among healthcare professionals or between healthcare professionals and patients. Poor communication is associated with complaints and mishaps. d: Shift: In a healthcare setting, shift refers to the rotation of works among healthcare professionals. In the United States, the traditional 8-hour work is becoming things of the past for nurses. Most healthcare organizations are mandating nurses to work 12-hour shifts. However, when shifts are combined with overtime, nurses face the risk of burnout and fatigue that may compromise patient care.

(Stimpfel, et al. 2012). e: Acute Care: An acute care is referred as the branch of healthcare where patients receive short-term and active treatments for different types of severe injuries. Acute care also provides healthcare services for patients in need of urgent medical conditions. Operational Definitions: a. Almost et al. (2015) argue that effective teamwork communication is an effective tool that reduces stress and burnout, improving patients' satisfaction as well as increasing job satisfaction. However, communication failure within healthcare leads to patient harm and ineffective teamwork. b.

PICOT has referred P ( patient problem or population), I (Intervention), C (comparison), and O (outcomes). c. Carlson, (2012) argues that insufficient or ineffective communication is a significant factor that contributes to adverse health effects. Communication failures in acute settings can increase patients' harms and intense caregiver dissatisfaction. d. Spooner et al. (2013) point out that effective clinical shift enhances leads to the provision of high quality, safe and continuing care. However, inaccurate and incomplete communication can lead to poor health outcomes in the intensive care unit.

Thus, miscommunication during clinical handover can reduce the quality of healthcare delivery. B. Guidelines of Applicable existing Clinical Practice 1."Pharmaceutical research and Manufacturers of America (PhRMA)" (PhrMa, 2015 p 1) shows that availability of information during the clinical trial assists in enhancing integrity and accuracy of care. By communicating information in a timely manner, it enhances quality healthcare delivery. 2. The "Centers for Disease Control and Prevention (CDC)" does not provide the recommendations to improve communication between shifts in acute care settings (CDC, 2016 p ). III.

Review of the literature justifying the need for this systematic review A. Conflicting findings with reference to adverse reactions in ineffective communication 1. Hughes, (2008) demonstrates that lack of effective communication can lead to medical errors, unexpected death or severe injury. Typically, medical errors occur when there is a communication breakdown in an acute care setting. Typically, Joint Commission reveals that medical error is among the top 10 of death in the United States. More specifically, communication failure can lead to delay in treatment, fatal falls and wrong-site surgeries. 2.

Dingley, Daugherty, Derieg, et al. (2008) argue that insufficient communication can lead to adverse events, the length of stay and patients harms. Moreover, ineffective communication leads to a delay in care delivery and intense caregiver dissatisfaction. 3. Stimpfel, Sloane, & Aiken, (2012) believe that increasing number of nurses are experiencing burnout because of the 12-hour shift that most acute care in the United States is adopting.

With the anticipating staffing changes and fluctuations in patients' need, the number of hours that nurses work in shift has been elongated making nurses face the risks of fatigue that can compromise patients care. 4.Lingard, (2004) in their argument believes that ineffective communication is the root cause of medical errors in the operating room. In essence, communication failures occur around 30% of the operating room between shifts in the United States. 5. "Acute care hospitals have become organizationally complex; this contributes to difficulty communicating with the appropriate health care provider.

Due to the proliferation of specialties and clinicians providing care to a single patient, nurses and doctors have reported difficulty in even contacting the correct health care provider". (Hughes, 2008 p 25). IV. Problem Statement A. Description of the problem 1.While the problems associated with the extended shifts have been identified, there is a limited research that has demonstrated the impact of long shifts on the effectiveness of nurses. Moreover, there is still a scanty research paper that has demonstrates the effect extended work hours on nurses. (Stimpfel, Sloane, & Aiken, 2012). 2.

Evidence have shown that communication failures have not been covered in more than 60% of sentinel events that has been reported by "Joint Commission on Accreditation of Healthcare Organizations". (Lingard, 2004 p 331). 3. In the acute care environment, a collaborative research to improve effective communication is lacking. Moreover, "human factors such as cognitive overload; the effects of stress, fatigue, distractions and interruptions; poor interpersonal communications; imperfect information processing; and flawed decision making are all known to contribute to errors in health care and other complex environments.". (Dingley, Daugherty. Derieg, et al. 2008 p 3). B.

Research Question In patients requiring acute care (P), does effective communication between shifts and universal standardized nursing report procedure (I) compared to ineffective communication environment (C), lead to quality patient care, decrease in medication errors, and prompt nursing intervention (O)? C. Purpose Statement: The purpose of the integrative systematic review is to discuss the adverse effect arisen from ineffective communication between shifts within acute care settings. V. Methods A. Search: communication, ineffective communication, acute care, shifts and effective communication. B. Databases: PubMed, CINHAL, Cochrane Database, Web of Science. C.

Inclusion Criteria: Studies will meet the inclusion criteria if they are: 1.Written in English; 2. Primary research that focuses on ineffective communication between shifts in acute care settings 3. Published between 2004 and 2016. D. Exclusion Criteria: Studies will not be included if they: 1. fail to meet quality appraisal minimum, and 2. Do not focus on ineffective communication between shifts in acute care settings E. Quality Appraisal 1. The research will screen the studies with the aid of the Quality Appraisal Review Checklist (Kmet, Lee, & Cook, 2004). 2.

Studies are to receive at least 3.0 points out of 5.0 points in order to be included in the review. F. Extraction data 1. Authors, country of origin and publication date 2. Purpose of the study 3. Sample and sampling method 4. Design & Limitations 5. Methods and Tools used 6. Findings and Results 7. Conclusions VI. Results A. The study found 298 articles using the abovementioned search criteria, however, 236 were excluded because they do not focus on ineffective communication between shifts within acute care settings. While two articles were not written in English, 28 were repeated articles.

After an assessment of the remaining 32 articles, four were descriptive research, one focused on literature systematic review, three were based on non-specific clinical guidelines, two were abstracts only, and three were protocols. B. Thus, three descriptive studies and 9 quasi-experimental studies were found appropriate for the review. However, one was found not meeting the rating for the quality appraisal minimum. C. Sample The complex process of assisting patients in the acute care requires effective interaction between patients and care providers.

However, ineffective communication between shift can lead to patients' readmission, adverse event and mortality. (Okoniewska, Santana, Groshaus, et al. 2015). Discussion A.To improve a current practice in the healthcare environment, it is revealed that there is a need to clear evidence to improve the effective communication between shifts to enhance quality acute care delivery. Typically, during the shifts, nurses encounter some challenges that contribute to gaps in patient care. Thus, ineffective shifts coupled with poor communication can lead to medication errors.

The study views that most information that nurses use in completing the medical plan is often incomplete or missing, inaccurate or sometimes conflicting. During the shift, nurses often emphasize the importance of contact information of discharging therapists, nurses and physicians. However, this information is rarely provided. Moreover, attempt to contact the staff in charge is often time-consuming and frustrating. (King.