Saturday, 16 October 2010

Saving lives through communication

Reproduced below is a study from Brazil, reported by Sergio Storch, translated by Google, and entitled "Communication gap between doctors causes fatal delays in procedures - Study with 792 patients showed that mortality rate drops when teams do more information sharing"

The Google Translation reads as follows
"The lack of communication between doctors in the ICU (intensive care unit) may increase the mortality rate, according to a study by a group linked to Windmills Hospital and University of Health Sciences of Porto Alegre. So severe, the problem is a priority of the campaign launched this week by the Brazilian Association of Critical Care Medicine in order to increase safety in intensive care units.

"Certainly, the lack of communication is the primary cause of adverse events in ICUs," says Alvaro Rea-Neto, campaign coordinator of the entity, which provides for meetings in various capitals.  The crowded environment of critical patients, the rush of professionals and lack of established routines to disseminate information creates a fertile ground for lack of communication.

Among the problems cited are the lack of meetings between all professionals involved, delays in proceedings as the beginning of a therapy with antibiotics, withdrawal of mechanical ventilation and techniques for prevention of deep vein thrombosis.  Experts also note the different perceptions of what is important to report, and difficulties that the younger members have to challenge the older and different visions of conduct within the team.

"A major problem is communication between different professionals. Not always what is communicated by one is the same as is heard by the other," says a specialist in critical care medicine Cassian Tan, a leader of the work.  "The ideal routine is one in which all participants of the event can meet at some point during the day to discuss the case." But that does not always happen.

 To reach the result, the researchers followed 792 patients for a year and a half.  They were divided into three groups according to frequency of communication between the medical assistant, who lead the case, but not spend all their time in ICU, and routine medical unit, responsible for acute complications.
The mortality rate was 26% in the group that rarely communicated, which included nearly 10% of patients. Those in which the conversations were almost daily, the rate was 13%.
"The important thing is not to find fault but to find processes that lead to (elimination of?)repetition of mistakes. If you do not take care of the process, not replace good people," says Rhea-Neto. 
 "It's a matter of habit, good will, but many teams have not developed this habit," says Mary Angela Paschoal Goncalves, chief nurse of the ICU of Hospital Santa Isabel and Santa Casa de São Paulo.
Well now, isn't that interesting, and worrying. Developing a process and a habit to talk about whats going on, and to share and communicate with each other, can cut the death rate in half. 10% of patients would be 79 people, a 23% death rate represents 18 people, and maybe 9 would still be alive if there had been more regular and more effective communication.

This reminds me of two things, one is the After Action Review habit developed by the Army, and the other is the Checklists of Atul Gawande. And it also suggests to me the importance of governance. If sharing knowledge within the teams could save 9 lives, then the Hospital administration needs to ensure that this conversation happens, and happens well. Good governance reinforces and embeds good habits.

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