Study Supports Training Clinicians in Communication Competency

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With Funding from National Patient Safety Foundation Research Grant, Study Looks at Change-of-Shift Reporting in the ICU

Dr. Patterson and her co-investigators have provided not only an analysis of an important opportunity for improvement, but also a useful tool to help clinicians conduct better handoffs.

Change-of-shift reporting, when clinical responsibility for a patient is handed off from one clinician to another, has been identified as an activity that can have an adverse impact on patient safety. Recommendations for improving the process largely focus on the outgoing clinician—the one reporting information about the patient. In a new study, researchers analyzed the interactions of incoming clinicians, specifically looking to identify differences in communication behaviors across disciplines and levels of training.

“We found that a higher level of training among incoming physicians and nurses was associated with fewer, but more meaningful, interjections. In other words, the more experienced clinicians knew that it was important to assertively question their peers when there might be inaccurate diagnoses or inappropriate treatment,” said Emily S. Patterson, PhD, principal investigator of the study. “This results in fewer breaks in thought for the clinician doing the reporting, but retains the potential to catch erroneous information or actions.”

Dr. Patterson, assistant professor at the Ohio State University College of Medicine, School of Health and Rehabilitation Sciences, received the 2010-2011 Hospira Research Grant at the National Patient Safety Foundation. This study is the primary outcome of that grant. The study’s findings were published in BMJ Quality & Safety (online first) on December 13, 2013.

Dr. Patterson’s team focused on attending physicians, resident physicians, registered nurses, and nurse practitioners in three medical intensive care units. Using a detailed classification system, the researchers observed communication behaviors during handoffs and analyzed the number of times the incoming clinician interrupted, the assertiveness of the interruption (for example, to clarify a potential error), and the clinicians’ level of training.

Among the study’s conclusions: The behaviors of the more highly trained physicians and nurses could be seen as communication competencies and potentially could be taught to improve handoffs overall. As an outcome, Dr. Patterson and her team developed online training materials that help resident physicians learn how to use active verbal engagement, ask clarifying questions, and perform a collaborative cross-check. These materials were demonstrated at the Human Factors and Ergonomics Society conference last fall see the (abstract).

“We are excited to see such tangible benefits come from this research,” said Tejal K. Gandhi, MD, MPH, CPPS, president, National Patient Safety Foundation. “Dr. Patterson and her co-investigators have provided not only an analysis of an important opportunity for improvement, but also a useful tool to help clinicians conduct better handoffs.”

The NPSF Research Grants Program has endeavored to stimulate innovative projects and promote research leading to the prevention of human errors, system errors, patient injuries, and the consequences of such adverse events in the health care setting. Since 1998, the program has supported 39 research projects with nearly $3.9 million in grant funding.

The grant awarded to Dr. Patterson was funded by Hospira, he global specialty pharmaceutical and medication delivery company that provides solutions to help improve the safety, cost, and productivity of patient care, and a member of the National Patient Safety Foundation’s Corporate Council.

For information about underwriting opportunities in support of the NPSF Research Grants Program, please contact David Coletta, senior vice president, at dcoletta(at)npsf(dot)org.

About the National Patient Safety Foundation
NPSF has been pursuing one mission since its founding in 1997 – to improve the safety of care provided to patients. As a central voice for patient safety, NPSF is committed to a collaborative, multi-stakeholder approach in all that it does. NPSF is an independent, not-for-profit 501(c)(3) organization. To learn more about the work of the National Patient Safety Foundation, and the NPSF Research Grants Program visit

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Patricia McTiernan
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