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A3624 - Why Don’t We Talk About Catheters? Characterizing Physician-Nurse Communication Barriers to Appropriate Catheter Use Discussions
Author Block: M. Manojlovich1, J. Ameling2, J. Forman3, S. Judkins2, M. Quinn4, J. Meddings2; 1School of Nursing, University of Michigan, Ann Arbor, MI, United States, 2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States, 3Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, United States, 4Center for Managing Chronic Disease, School of Public Health, University of Michigan, Ann Arbor, MI, United States.
Rationale
Healthcare-associated infections (HAIs) result in approximately 75,000 deaths and up to $45 billion in hospital costs every year. Many HAIs are caused by indwelling urinary and vascular catheters, affecting up to 10% of hospitalized patients. Despite multi-intervention bundle strategies, reducing unnecessary urinary and vascular catheter use remains a challenge, one that is dependent upon effective communication between nurses and physicians. We sought to characterize communication-related barriers between physicians and nurses and understand how these barriers affect appropriate use and/or removal of indwelling urinary and vascular catheters.
Methods
Nurses, physicians, physician assistants (PAs), and Nurse Practitioners (NPs) who provided care for patients on the pulmonary progressive care unit of a large tertiary care teaching hospital were invited to participate in face-to-face, semi-structured individual or small group interviews. Interview questions focused on monitoring and communicating indwelling catheter-related information among members of the care team. All interviews were audio-recorded, professionally transcribed, and anonymized. We used content analysis to identify common themes and mapped them to a conceptual framework highlighting contextual barriers to communication in three domains: organizational, cognitive, and social complexity.
Results
Ten nurses, 7 physicians, 3 PAs, and 1 NP participated in a total of 13 individual and 4 small group interviews. Participants commented on both indwelling urinary and vascular catheters. Organizational complexity created communication barriers through misalignment of physician
and nurse workflows which made it difficult for nurses to attend rounds, a critical venue for discussion of catheter use. Communication barriers related to cognitive complexity - the cognitive load required for communicators to convey and understand a message - were: uncoordinated use of both paper and the electronic medical record (EMR) to retrieve and record information related to catheter documentation and tracking; difficulty locating information in the EMR needed to make decisions on catheter use, and one-way communication through pagers that precluded full discussion of catheter removal. Barriers related to social complexity were: poor relationships between physicians and nurses, communication silos, and differing physician and nurse priorities based on differences in roles and responsibilities.
Conclusions
Organizational, cognitive, and social communication-related barriers between physicians and nurses contributed to inappropriate use and lack of timely removal of indwelling urinary and vascular catheters. Overcoming these barriers will take more than teaching nurses and physicians how to communicate with each other. Until the contribution of context is recognized, improvements to communication about subjects such as appropriate catheter use may continue to falter.