Ineffective Communication Between Shifts in Acute Care
This integrative systematic review examines the adverse effects of ineffective communication between shifts in acute care settings. Drawing on studies published between 2004 and 2016, the paper explores how communication failures contribute to medication errors, sentinel events, patient readmissions, and mortality. It quantifies the economic burden — estimated between $17 billion and $19 billion annually in the United States — and reviews key conceptual definitions, clinical practice guidelines, and a structured literature search across PubMed, CINAHL, the Cochrane Database, and Web of Science. The review concludes that stakeholders must invest in financial and human resources, standardized handover procedures, and targeted staff training to improve communication quality and patient safety in acute care environments.
- Introduction and Significance: Scope and prevalence of adverse shift-communication effects
- Consequences and Costs of Ineffective Shift Communication: Clinical harms and multi-billion-dollar economic burden
- Background: Key Definitions and Clinical Guidelines: Conceptual and operational definitions of key terms
- Literature Review: Conflicting Findings: Evidence on errors, burnout, and operating room failures
- Problem Statement, Research Question, and Methods: PICOT question, search strategy, and appraisal criteria
- Results and Discussion: Article screening results and practice improvement findings
- Conclusion: Call for resources and standardized communication strategies
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What makes this paper effective
- The paper anchors its argument in concrete statistics — adverse event rates, dollar figures, and malpractice costs — which gives the problem statement measurable weight and makes the urgency of intervention tangible.
- It follows a structured systematic-review format, moving logically from problem definition to background, literature review, methods, results, and discussion, which signals methodological rigor appropriate for a healthcare research context.
- The inclusion of both conceptual and operational definitions demonstrates awareness of how key terms carry different meanings across studies, strengthening the review's analytical framework.
Key academic technique demonstrated
The paper demonstrates PICOT-structured clinical question formulation, a standard technique in evidence-based healthcare research. By explicitly identifying Population, Intervention, Comparison, and Outcome, the author transforms a broad problem into a testable, reviewable research question — a model approach for systematic and integrative reviews in nursing and health sciences literature.
Structure breakdown
The paper opens with a significance statement supported by epidemiological statistics, then moves through consequences, financial costs, definitional background, a multi-source literature review, a formal methods section (including inclusion/exclusion criteria and quality appraisal), and closes with results, discussion, and a brief conclusion. This mirrors the IMRaD structure common in health sciences writing, adapted for an integrative review format.
Introduction and Significance
Recent statistics on the adverse effects arising from ineffective communication between shifts in acute care settings range from 2.6% to 7.6%; however, Okoniewska et al. (2015) estimate that the adverse effects on inpatients can be between 19% and 23% (Classen, Resar, Griffin, et al., 2011). This review aims to discuss the adverse effects arising from ineffective communication between shifts within acute care settings.
Consequences and Costs of Ineffective Shift Communication
Without implementing strategies to 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 in therapeutic errors (Okoniewska et al., 2015). Lack of intervention can also lead to medical errors and patient harm. Communication failure has been identified as the root cause of more than 70% of sentinel events and contributes to greater resource use, longer patient stays, caregiver dissatisfaction, and rapid caregiver turnover. Unaddressed ineffective communication can also jeopardize patient safety by "increasing tension, increasing cognitive load, and interrupting routine in the healthcare system" (Lingard, 2004, p. 330; Dingley, Daugherty, Derieg, et al., 2008).
King et al. (2013) argue that poor communication between shifts has been identified as the strongest predictor of 30-day re-hospitalization. Failure to identify and address these issues can lead to cultural clashes, blame, and unrealistic expectations. Inadequate discharge communication can have a negative impact on patients' families and staff within a care setting. Inaccurate information can also produce care delays due to the time-consuming process of recording and gathering the information necessary to implement a safe and effective healthcare plan. In orthopedic care specifically, ineffective communication can lead to an increased risk of re-hospitalization and mobility issues (King et al., 2013).
The gravity of adverse effects from ineffective communication has contributed to estimated total costs of between $17 billion and $19 billion annually in the United States. Similarly, the economic burden of ineffective communication in acute care settings in Canada is estimated at $1.1 billion (Dingley et al., 2008). The costs of poor communication were also estimated to have reached $1.7 billion in malpractice costs, leading to the loss of approximately 2,000 lives in 2009.
Ritu, Daniel, Diaz, et al. (2010) used an economic model to demonstrate the costs of ineffective communication between shifts. These costs include waste in nurse time, physician time, and patient length of stay. For example, costs associated with wasted physician time are estimated at $800 million annually. Communication inefficiencies also lead to waste of more than $4.9 billion annually due to lost nurse time. Since the demand for nursing professionals exceeds supply, unproductive use of nurses' time further aggravates resource constraints. Increased length of stay attributable to ineffective communication accounts for an additional economic loss of approximately $6.6 billion annually.
Background: Key Definitions and Clinical Guidelines
Communication: In a healthcare setting, communication is defined as an exchange of information between healthcare professionals to enhance effective diagnosis and delivery of acute care.
Effective Communication: This is a reciprocal and interactive process among healthcare professionals. It involves a sender and recipients and is critical to ensuring that messages are received and understood. The ability to communicate effectively leads to accurate patient diagnosis and enhanced acute care delivery.
Ineffective Communication: Ineffective communication is the breakdown of communication among healthcare professionals, or between healthcare professionals and patients. Poor communication is associated with complaints and mishaps.
Shift: In a healthcare setting, a shift refers to the rotation of duties among healthcare professionals. In the United States, the traditional 8-hour workday is becoming less common for nurses. Most healthcare organizations are mandating 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).
Acute Care: Acute care refers to the branch of healthcare in which patients receive short-term, active treatment for severe injuries or urgent medical conditions.
Almost et al. (2015) argue that effective teamwork communication reduces stress and burnout, improves patient satisfaction, and increases job satisfaction. However, communication failure within healthcare leads to patient harm and dysfunctional teamwork.
PICOT refers to: P (patient problem or population), I (intervention), C (comparison), and O (outcomes).
Carlson (2012) argues that insufficient or ineffective communication is a significant factor contributing to adverse health effects. Communication failures in acute settings can increase patient harm and intensify caregiver dissatisfaction.
Spooner et al. (2013) point out that effective clinical shift handover leads to the provision of high-quality, safe, and continuous care. Inaccurate and incomplete communication can lead to poor health outcomes in the intensive care unit, and miscommunication during clinical handover can reduce the overall quality of healthcare delivery.
The Pharmaceutical Research and Manufacturers of America (PhRMA, 2015) notes that the availability of information during clinical trials assists in enhancing the integrity and accuracy of care. Communicating information in a timely manner enhances quality healthcare delivery.
The Centers for Disease Control and Prevention (CDC) does not currently provide specific recommendations to improve communication between shifts in acute care settings (CDC, 2016).
Conclusion
The present study provides a systematic review of the literature on ineffective communication between shifts in acute care settings. The findings highlight key issues including ineffective communication practices, shift handover gaps, and lack of resources. The study recommends that stakeholders provide both financial and human resources to facilitate effective communication between shifts in the acute care environment.
Aebersold, M., Averhart, V., Keenan, G., Kocan, M. J., Lundy, F., & Tschannen, D. (2011). Implications of nurse-physician relations: Report of a successful intervention. Nursing Economics, 29(3), 127–135.
Almost, J., Wolff, A., Mildon, B., Price, S., Godfrey, C., Robinson, S., . . . Mercado-Mallari, S. (2015). Positive and negative behaviors in workplace relationships: A scoping review protocol. BMJ Open, 5(2). doi:10.1136/bmjopen-2015-007685
Carlson, E. A. (2012). Improving patient safety through improved communication and teamwork. Orthopaedic Nursing, 31(3), 190–192.
Classen, D. C., Resar, R., Griffin, F., et al. (2011). "Global trigger tool" shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs (Millwood), 30(4), 581–589.
Dingley, D., Daugherty, K., Derieg, M. K., et al. (2008). Improving patient safety through provider communication strategy enhancements. Advances in Patient Safety: New Directions and Alternative Approaches, 3.
Hughes, R. (2008). Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.
King, B. J., Gilmore-Bykovskyi, A. L., Roiland, R. A., Polnaszek, B. E., Bowers, B. J., & Kind, A. J. (2013). The consequences of poor communication during transitions from hospital to skilled nursing facility: A qualitative study. Journal of the American Geriatrics Society, 61(7), 1095–1102. doi:10.1111/jgs.12328
Kmet, L. M., Lee, R. C., & Cook, L. S. (2004). Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Alberta Heritage Foundation for Medical Research. Retrieved from
Lingard, L. (2004). Communication failures in the operating room: An observational classification of recurrent types and effects. Quality and Safety in Health Care, 13(5), 330–334. doi:10.1136/qhc.13.5.330
Okoniewska, B., Santana, M. J., Groshaus, H., Stajkovic, S., Cowles, J., Chakravorty, D., & Ghali, W. (2015). Barriers to discharge in an acute care medical teaching unit: A qualitative analysis of health providers' perceptions. Journal of Multidisciplinary Healthcare, 83–89.
PhRMA. (2015). Principles of conduct of clinical trials: Communication of clinical trial results. Pharmaceutical Research and Manufacturers of America.
Ritu, A., Daniel, S., Diaz, S. S., et al. (2010). Quantifying the economic impact of communication inefficiencies in U.S. hospitals. Journal of Healthcare Management, 55(4), 265–281.
Spooner, A. J., Chaboyer, W., Corley, A., Hammond, N., & Fraser, J. F. (2013). Understanding current intensive care unit nursing handover practices. International Journal of Nursing Practice, 19(2), 214–220. doi:10.1111/ijn.12058
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501–2509.
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