Monday, October 27, 2014

Communication in the hospital setting

Communication in the hospital is essential. Patients have several staff members taking care of them and staff has many different patients to take care of. Lack of communication can have serious repercussions. Most medical errors can be traced to lack of communication. Whiteboards serve as a very valuable way to facilitate communication.  I spent several years working the in the hospital, in both inpatient units and the emergency departments and hospital whiteboards have been important in every hospital setting I have ever worked in.
The inpatient unit is a busy place. Patients come and go quickly. Whiteboards are a central place where secretaries can locate a patient, figure out which nurse is caring for them and figure out what tests they have having done. Many people come to the unit looking for a specific patient and patient care whiteboards are a good way to find the information they need quickly. A lot of units also have another board with important phone numbers. This is very useful to the nurses who may need to reach a doctor in a hurry. Having all the important phone numbers right in front of them can be a huge help.
With a revolving door of staff members, patients often can’t keep their caregivers straight or remember their nurse’s name or even the date. Families may not be able to be present for rounds and may feel like they don’t know what is going on. In order to help these problems, each patient room has a whiteboard. These magnetic whiteboards are used to record information such as the date, room number and nurse caring for the patient. It is also a useful place to record information the patient needs reminding about such as walking three times per day or asking for help before getting up. Staff can also keep track of intake and output and family members can write down questions for the health care team.
I have also worked in the emergency department. The whiteboards in the ED are also used as a central point of communication. Staff gathers around the board for signout at shift change. The board is used to record the patient’s name, room number, diagnosis, doctor and nurse taking care of the patient. The ED staff can also record what needs to be done for the patient or what they are waiting for. It is a very important tool to keep everyone on the same page.
Whiteboards are also very important in the operating room. OR rooms turn over quickly and everyone needs to know what’s going on. The central OR board usually has the patient’s name, diagnosis, surgical procedure, surgeon and expected time of surgery. These whiteboards serve as a central communication point where everyone can know what is going on.
Electronic medical records can also be a helpful tool in improving communication between staff members. However, they do have limitations. The location of the computer may not be ideal or immediately available or some staff may not have access to the computer. It can be difficult to make changes to a program or worst case the computer system may go off-line at a critical time making it difficult to get information about the patient quickly in the case of emergency.  I worked in one emergency department who had gotten rid of the whiteboard when they started using an electronic medical record. One night the computer system went out and it became immediately apparent that no one had come up with a backup plan! The nurses didn't know who was in each room and had to go around the unit “checking” which patient was in each room. This was a case where a whiteboard would have prevented this from happening.  It serves as a good compliment to the EMR and is not sensitive to power outages!


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