Barriers to effective, safe communication and workflow between nurses and non-consultant hospital doctors during out-of-hours

Abstract

Objective: This study aimed to evaluate the nature and type of communication and workflow arrangements between nurses and doctors out-of-hours (OOH). Effective communication and workflow arrangements between nurses and doctors are essential to minimize risk in hospital settings, particularly in the out-of-hour's period. Timely patient flow is a priority for all healthcare organizations and the quality of communication and workflow arrangements influences patient safety. Design: Qualitative descriptive design and data collection methods included focus groups and individual interviews Setting: A 500 bed tertiary referral acute hospital in Ireland. Participants: Junior and senior Non-Consultant Hospital Doctors, staff nurses and nurse managers. Results: Both nurses and doctors acknowledged the importance of good interdisciplinary communication and collaborative working, in sustaining effective workflow and enabling a supportive working environment and patient safety. Indeed, issues of safety and missed care OOH were found to be primarily due to difficulties of communication and workflow. Medical workflow OOH is often dependent on cues and communication to/from nursing. However, communication systems and, in particular the bleep system, considered central to the process of communication between doctors and nurses OOH, can contribute to workflow challenges and increased staff stress. It was reported as commonplace for routine work, that should be completed during normal hours, to fall into OOH when resources were most limited, further compounding risk to patient safety. Conclusion: Enhancement of communication strategies between nurses and doctors has the potential to remove barriers to effective decision-making and patient flow.