Abstract
IntroductionAfter patient care transitions occur, communication from the current physician back to the transferring physician may be an important source of clinical feedback for learning from outcomes of previous reasoning processes. Factors associated with this communication are not well understood. This study clarifies how often, and for what reasons, current physicians do or do not communicate back to transferring physicians about transitioned patients.MethodsIn 2018, 38 physicians at two academic teaching hospitals were interviewed about communication decisions regarding 618 transitioned patients. Researchers recorded quantitative and qualitative data in field notes, then coded communication rationales using directed content analysis. Descriptive statistics and mixed effects logistic regression analyses identified communication patterns and examined associations with communication for three conditions: When current physicians 1) changed transferring physicians’ clinical decisions, 2) perceived transferring physicians’ clinical uncertainty, and 3) perceived transferring physicians’ request for communication.ResultsCommunication occurred regarding 17% of transitioned patients. Transferring physicians initiated communication in 55% of these cases. Communication did not occur when current physicians 1) changed transferring physicians’ clinical decisions (119 patients), 2) perceived transferring physicians’ uncertainty (97 patients), and 3) perceived transferring physicians’ request for communication (12 patients). Rationales for no communication included case contextual, structural, interpersonal, and cultural factors. Perceived uncertainty and request for communication were positively associated with communication (p < 0.001) while a changed clinical decision was not.DiscussionCurrent physicians communicate infrequently with transferring physicians after assuming patient care responsibilities. Structural and interpersonal barriers to communication may be amenable to change. Clarity about transferring physicians’ uncertainty and desire for communication back may improve clinical feedback communication.Electronic supplementary materialThe online version of this article (10.1007/s40037-020-00585-1) contains supplementary material, which is available to authorized users.
Highlights
After patient care transitions occur, communication from the current physician back to the transferring physician may be an important source of clinical feedback for learning from outcomes of previous reasoning processes
Perceived uncertainty and request for communication were positively associated with communication (p < 0.001) while a changed clinical decision was not
After-transition communication from current physicians back to transferring physicians could close this clinical feedback loop, but the frequency of and factors associated with this communication are not well understood
Summary
After patient care transitions occur, communication from the current physician back to the transferring physician may be an important source of clinical feedback for learning from outcomes of previous reasoning processes Factors associated with this communication are not well understood. As a consequence of several forces, including efficiency demands, patient safety, and specialization, physicians often work as site-based specialists in designated blocks of time [1,2,3] These structures require transferring physicians, those initially responsible for clinical reasoning decisions, to transition patients to current physicians. Unlike temporary patient handovers where physicians subsequently return to care for the same patients, these transitions disrupt the transferring physician’s clinical reasoning processes Outcomes of decisions they made before the transition may not become known unless follow-up occurs. If communication does not occur, opportunities to learn and improve future clinical reasoning processes may be lost [5]
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