How Well Do We Communicate?

Abstract

Introduction: It is a duty of NHS trusts and stroke services to ensure that people who have suffered a stroke and their families are kept well informed'. The National Sentinel Audit for Stroke highlighted poor communication as the foremost cause of dissatisfaction and reason for complaint. We therefore audited our department to see if we were meeting the gold standard of '100% of all families should be informed of diagnosis, management and prognosis after a stroke within 72 hours' (National Clinical Guideline for Stroke recommendation 7.6.1). Method: We reviewed 50 consecutive acute admissions. The time from admission to first documented discussion, grade of doctor, and nature of discussion were recorded. We also looked at whether there was any relationship between NIHSS score, (a surrogate of stroke severity), and grade of doctor. Results: Percentage with documented discussion <72 hours = 62% Most common themes documented = diagnosis (21%), mortality and morbidity (18.5%). Initial discussions by FY1 (31%) and consultant (28%). This was not affected by NIHSS score. However, consultants were more likely to discuss DNAR. Discussion: Is it appropriate for FY1 doctors to have initial discussions? Are they prepared to discuss DNAR? With faster transfer of patients between units it is increasingly important that documentation is clear to aid clarity for clinicians as well as patients / relatives. We have introduced a new communication form and review its impact. In the longer term we will see if this affects patient / carer satisfaction.