Interspecialty Communication Research Articles

8 A prospective audit on outpatient clinical activity in a consultant-led general medical and specialist geriatric clinic

Abstract Background It is recognised that there is a significant unprecedented pent-up demand on Irish healthcare services due to the COVID-19 pandemic. This has resulted in lengthy acute hospital scheduled care waitlists. We identified a national protocol that provides guidance in the area of outpatient waiting list management. The aim of this audit was to determine if our practice was consistent with national guidance. Methods We conducted a prospective audit on a consultant-led medical and specialist geriatric clinic between January to March 2023 and collected data in relation to referral reason, triage category, waitlist times, clinic attendance, hospital admissions, inter-specialty communication and resolution of clinical problem prior to outpatient clinic attendance. Results We included 67 patient appointments in this audit. Median waitlist time was 15.5 weeks. There were 2 urgent referrals, both were not seen within the Clinically Recommended Timeframe (CRT). 94% were seen within the CRT. 11 patients (16.4%) failed to attend their clinic appointment, only 3 of which cancelled beforehand. 5 patients (7.5%) were inpatients during waitlist time and 4 had reason for outpatient referral addressed during their inpatient stay. 8 patients (11.9%) had same referrals sent to a second point of contact, only 5 had correspondence available in medical records at time of audit. Conclusion Our findings indicate that the majority of our waitlist times fall within national target recommendations, however more robust pathways need to be developed to ensure urgent referrals are seen promptly. They also indicate inter-specialty and patient communication need to be enhanced to minimise duplicate or unnecessary appointments that add to waitlist burden.

Updated Trends of Fractures, A Single Trauma Centre Prospective Observational Study

Background Trauma, specifically physical trauma, is the damage to the body caused by an external force. This may be caused by accidents, falls, hits, weapons, and other causes.In medicine, traumatology is defined as the study of wounds and injuries caused by accidents or violence to a person, together with the surgical therapy and repair of this damage. Aim of the Work This study primarily aims to identify the prevalence of fractures in our population and fracture patterns as regards the age, the gender, the comorbidities of the patients, the mode of trauma, the classification, the associated injuries and the management at our institute. Patients and Methods This study is a cross sectional observational study in which the STROBE layout was used. It was conducted in a university hospital which is considered as a tertiary trauma center “Ain Shams University hospital.”. Data regarding the patients were collected over a period of six months started from the first of January 2021 and ended by the end of June 2021. No follow up was needed for any patients. Results Results showed that most prevalent fractures were femur fractures especially in geriatrics, followed by radius fractures that mainly occurred in pediatric age group, tibial fractures were the third most common fractures and mainly affected adult age group, humeral fractures were the fourth most common with pediatrics age group mainly affected. Malleolar fractures were the fifth prevalent fractures followed by the ulnar fractures. Conclusion Fracture prevalence numbers vary substantially according to age and gender for different locations and presumably the percentage of osteoporotic fractures are on the rise. Careful assessment of fragility fractures is needed, developing a trauma registry and filing systems is mandatory in order to accurately collect and save this important data. Femur fractures especially geriatric femur fractures, radius especially distal end and tibial fractures (especially the shaft), accordingly the learning curve should be guided towards mastering the management of those fractures. Hospital preparation, instrumentation and creation of special dedicated units like the orthogeriatric unit should be encouraged to provide better care for patients along with enhancing the inter-specialty communication and aiming for multi-disciplinary team management. Data from the study should be implemented nationwide to help develop preventative strategies aiming for lowering the occurrence of fractures

Prevalence and identification of neuropsychiatric symptoms in systemic autoimmune rheumatic diseases: an international mixed methods study.

A limited range of neuropsychiatric symptoms have been reported in systemic autoimmune rheumatic diseases (SARDs), with varied symptom prevalence. This study aimed to investigate a wider range of potential symptoms than previous studies, compare patient self-reports with clinician estimates, and explore barriers to symptom identification. Mixed methods were used. Data from SARDs patients (n = 1853) were compared with controls (n = 463) and clinicians (n = 289). In-depth interviews (n = 113) were analysed thematically. Statistical tests compared means of survey items between patients and controls, 8 different SARD groups, and clinician specialities. Self-reported lifetime prevalences of all 30 neuropsychiatric symptoms investigated (including cognitive, sensorimotor and psychiatric) were significantly higher in SARDs than controls. Validated instruments assessed 55% of SARDs patients as currently having depression and 57% anxiety. Barriers to identifying neuropsychiatric symptoms included: (i) limits to knowledge, guidelines, objective tests and inter-speciality cooperation; (ii) subjectivity, invisibility and believability of symptoms; and (iii) under-eliciting, under-reporting and under-documenting. A lower proportion of clinicians (4%) reported never/rarely asking patients about mental health symptoms than the 74% of patients who reported never/rarely being asked in clinic (P < 0.001). Over 50% of SARDs patients had never/rarely reported their mental health symptoms to clinicians, a proportion underestimated at <10% by clinicians (P < 0.001). Neuropsychiatric symptom self-reported prevalences are significantly higher in SARDs than controls, and are greatly underestimated by most clinicians. Research relying on medical records and current guidelines is unlikely to accurately reflect patients' experiences of neuropsychiatric symptoms. Improved inter-speciality communication and greater patient involvement is needed in SARD care and research.

July effect in clinical outcomes of esophagogastroduodenoscopy performed at teaching hospitals in the United States

Background Esophagogastroduodenoscopy (EGD) is a common procedure used for both diagnosis and treatment, but carries risks such as bleeding and perforation. The “July effect”—described as increased complication rates during the transition of new trainees—has been studied in other procedures, but has not been thoroughly evaluated for EGD. Methods We used the National Inpatient Sample database for 2016 to 2018 to compare outcomes in EGD performed between July to September and April to June. Results Approximately 0.91 million patients in the study received EGD between July to September (49.35%) and April to June (50.65%), with no significant differences between the two groups in terms of age, gender, race, income, or insurance status. Of the 911,235 patients, 19,280 died during the study period following EGD, 2.14% (July–September) vs 1.95% (April–June), with an adjusted odds ratio of 1.09 (P < 0.01). The adjusted total hospitalization charge was $2052 higher in July–September ($81,597) vs April to June ($79,023) (P < 0.005). The mean length of stay was 6.8 days (July–September) vs 6.6 days (April–June) (P < 0.001). Conclusions The results of this study are reassuring as the July effect on inpatient outcomes for EGDs was not significantly different according to our study. We recommend seeking prompt treatment and improving new trainee training and interspecialty communication for better patient outcomes.

Interspeciality Othering: A Qualitative Analysis of Physician Interpersonal Conflict at the Time of Admission From the Emergency Department.

Purpose: Communication, teamwork, and conflict navigation among physician colleagues are core competencies for graduate medical trainees. 1 Yet, how these core elements of professional behavior are enacted in practice remains poorly characterized, and interpersonal interactions continue to be a central source of workplace conflict. 2,3 While this threat to an effective learning environment has been described in the nursing literature, 4 physicians’ experience of conflict with other physician colleagues remains poorly characterized. The goal of this study was to gain a more nuanced understanding of interphysician conflict to provide foundational guidance for how training communities can support best practices and curricular innovation regarding communication. Methods: Using a constructivist grounded theory approach, the authors explored the perceptions of interpersonal interactions of emergency medicine (EM) and internal medicine (IM) clinicians, using conversations regarding hospital admissions as a critical interface between members of these 2 disciplines. The authors used a purposive sampling approach to recruit participants and included EM residents and attending physicians and IM attending physicians who serve in the triage hospitalist role. Two authors conducted hour-long, semistructured interviews over Zoom. The 2 primary investigators then coded the transcripts according to Charmaz’s 5 3 stages of coding: initial, focused, and theoretical. Investigators used a constant comparative and integrative analysis to refine the interview guide, and interviews continued until thematic sufficiency was reached. Results: The authors interviewed 18 participants for this study, including 9 IM faculty and 9 EM providers (4 faculty, 5 residents). Participants identified primers, modifiers, consequences, and solutions to interphysican conflict. They described how preconceived perceptions of their colleagues’ specialty and misalignments in expectations around clinical care primed the learning environment for conflict. EM and IM providers also emphasized the role of word choices in creating mutual feelings of being undervalued, disempowered, and having their clinical judgment questioned. They described important personal and professional consequences that occurred secondary to this conflict, such as stress, burnout, job dissatisfaction, self-doubt, questioning their choice of medical specialty, and concerningly they expressed these encounters reinforced bias and stereotyping among specialties. Finally, providers suggested strategies to repair conflictual interactions and improve communication. They noted that focusing on honesty, empathy, teaching, and active team formation could be used to resolve or avoid conflict. Discussion: Our data suggest that interpersonal conflict between physicians is a pervasive issue. Participants describe that these encounters impact both their professional and personal wellness, which aligns with the broader workplace conflict literature. Interspecialty “othering” and preexisting biases and stereotypes prime the workplace for these conflictual interactions. They also serve as a lens to interpret misaligned expectations and difference of opinion as error, clinical incompetence, and work avoidance, which further propagate conflict. Trainees are exposed to interspeciality othering and expressions of other specialties’ relative inferiority early in training. These attitudes are often modeled by supervisors and play a role in specialty identity formation. Finally, propagation of bias and stereotyping is a concerning consequence of interphysican conflict and may serve to further the divide between EM and IM providers. Empathy, honesty, and mutual teaching are important strategies to combat stereotyping and othering and may help mitigate the deleterious consequences of interphysican conflict. Significance: Educators should specifically target interventions to foster improved interspecialty communication to promote conflict navigation and teamwork competencies. Learners need to not only understand how to give a structured handoff but also have strategies for both preventing conflict and navigating it once it does occur. Additionally, it is critical for educators to be mindful of the role that our words, actions, and attitudes play in influencing trainees’ perspectives of other specialties.

Multidisciplinary Approaches for Transthyretin Amyloidosis.

Amyloidosis caused by systemic deposition of transthyretin (TTR) is called ATTR amyloidosis and mainly includes hereditary ATTR (ATTRv) amyloidosis and wild-type ATTR (ATTRwt) amyloidosis. Until recently, ATTRv amyloidosis had been considered a disease in the field of neurology because neuropathic symptoms predominated in patients described in early reports, whereas advances in diagnostic techniques and increased recognition of this disease revealed the presence of patients with cardiomyopathy as a predominant feature. In contrast, ATTRwt amyloidosis has been considered a disease in the field of cardiology. However, recent studies have suggested that some of the patients with ATTRwt amyloidosis present tenosynovial tissue complications, particularly carpal tunnel syndrome, as an initial manifestation of amyloidosis, necessitating an awareness of this disease among neurologists and orthopedists. Although histopathological confirmation of amyloid deposits has traditionally been considered mandatory for the diagnosis of ATTR amyloidosis, the development of noninvasive imaging techniques in the field of cardiology, such as echocardiography, magnetic resonance imaging, and nuclear imaging, enabled nonbiopsy diagnosis of this disease. The mechanisms underlying characteristic cardiac imaging findings have been deciphered by histopathological studies. Novel disease-modifying therapies for ATTR amyloidosis, such as TTR stabilizers, short interfering RNA, and antisense oligonucleotides, were initially approved for ATTRv amyloidosis patients with polyneuropathy. However, the indications for the use of these disease-modifying therapies gradually widened to include ATTRv and ATTRwt amyloidosis patients with cardiomyopathy. Since the coronavirus disease 2019 (COVID-19) pandemic, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, occurred, the minimization of hospital visits and telemedicine have become increasingly important. As older age and cardiovascular disease are major factors associated with increased disease severity and mortality of COVID-19, many ATTR amyloidosis patients are at increased risk of disease aggravation when they are infected with SARS-CoV-2. From this viewpoint, close interspecialty communication to determine the optimal interval of evaluation is needed for the management of patients with ATTR amyloidosis.

154 Enhancing Communication Between Foundation Doctors and Radiologists

Abstract Introduction Facilitating radiological imaging for patients is an essential task for all Foundation Year (FY) doctors. Achieving competence in this task can expedite patient management. We evaluated the confidence and skills of FYs in facilitating radiological imaging before and after introduction of formal training. Method Surgical FYs working at a teaching hospital were surveyed to evaluate their baseline level of competence in booking and discussing imaging with radiology colleagues. Parameters were measured on a Likert scale, including confidence in discussing requests and satisfaction of their own performance following discussions. Eight radiology consultants were surveyed to evaluate their opinions on FYs’ communication and established areas for improvement. A teaching session was then delivered to improve communication skills. Furthermore, PACCSS poster was introduced to remind the FYs of the salient information required when discussing imaging. Results One month after the intervention, the participants were re-surveyed. This demonstrated a statistically significant improvement in self-reported confidence from 5.3/10 to 7.3/10 (p &amp;lt; 0.001), and in satisfaction of own performance from 5.4/10 to 7.0/10 (p &amp;lt; 0.001). Conclusions We identified deficiencies in surgical FY doctors’ confidence and skills in facilitating radiological imaging. There was a demonstrable benefit with focused training. Inter-specialty communication should be introduced into under- and post-graduate educational curriculum.

Enhancing communication between foundation doctors and radiologists: a quality improvement project

Facilitating radiological imaging for patients is an essential task for foundation year (FY) doctors. Achieving competence in this task can significantly enhance patient management. We evaluated the confidence and skills...

Practical Considerations for Implementing Virtual Care in Physical Medicine and Rehabilitation: For the Pandemic and Beyond.

This article outlines a practical approach to quickly implementing virtual care for physiatrists. This skill is relevant not only during times of a pandemic, when face to face care is impossible, but is also valuable when caring for patients who have physical, financial, logistic, or other challenges to on-site care. Key themes covered in this article include selecting appropriate virtual care platforms, consenting patients for virtual care and conducting successful virtual visits. It also reviews strategies for performing virtual physical examinations and engaging learners in virtual care.

Examining Referral Patterns between Otolaryngology and Gastroenterology: A Window into Potential Inter-Specialty Knowledge Gaps

The objective of this study was to examine referral patterns between otolaryngology and gastroenterology in order to delineate areas of clinical overlap, as well as to identify areas that might benefit from improved inter-specialty communication and collaboration. Montefiore's Clinical Looking Glass tool was used to define parameters for electronic medical record data extraction from 2015 to 2018. Two cohorts were generated, one representing referrals placed by gastroenterology to otolaryngology and a second representing referrals placed by otolaryngology to gastroenterology. The ICD-10 codes in both cohorts were reviewed and 13 distinct "reason for referral" categories were defined. The rates of referral for each category were then calculated for each of the referral cohorts. Otolaryngology referred to gastroenterology at a greater rate than gastroenterology referred to otolaryngology, despite seeing fewer total patients than gastroenterology. For referrals from gastroenterology to otolaryngology, the three most frequent referral reasons were oral cavity/oropharyngeal pathology (28.3%), dysphagia (28.3%), and gastroesophageal reflux disease/laryngopharyngeal reflux disease (GERD/LPRD) (11.3%). For referrals from otolaryngology to gastroenterology, the three most frequent referral reasons were GERD/LPRD (61.7%), dysphagia (18.6%), and esophageal pathology (5.3%). GERD/LPRD was more frequently referred out by otolaryngology than it was by gastroenterology, suggesting the need for further characterization of the discrepancy in management of a disease commonly treated by both specialties. The discrepant rates of referral for dysphagia also suggest a need to better understand what factors contribute to the differences in management of another clinical condition commonly assessed by both specialties. 4.

Online referrals improve interspecialty communication and are preferred by referring clinicians.

At a large university foundation teaching hospital multiple systems were in use to request inpatient review by other specialties. Thus referral was extremely time-consuming: over 91% of referrers stated that finding out how to refer to each specialty took a significant amount of time. Over 97% stated they would save a significant amount of time if a formal document detailing referral processes existed or if there was a unified process of referring. Conversely, within gastroenterology, where referrals were received by fax, review of referrals over a 1-month period revealed that 62% of referrals could be dealt with by telephone …

Online referrals improve interspecialty communication and are preferred by referring clinicians

At a large university foundation teaching hospital multiple systems were in use to request inpatient review by other specialties. Thus referral was extremely time-consuming: over 91% of referrers stated that finding out how to refer to each specialty took a significant amount of time. Over 97% stated they would save a significant amount of time if a formal document detailing referral processes existed or if there was a unified process of referring. Conversely, within gastroenterology, where referrals were received by fax, review of referrals over a 1-month period revealed that 62% of referrals could be dealt with by telephone …

Communication training for inter‐specialty clinicians

Inter-specialty clinicians often co-lead family conferences for hospitalised patients. Families frequently report receiving different messages from different clinicians. We developed a communication training workshop that crosses disciplines and co-trains clinicians in one setting to create a culture of delivering a unified message. We developed a 2-day paediatric communication skills workshop to teach the skills necessary to conduct a family conference. The workshop was targeted at nurse-practitioners and faculty clinicians representing the different specialties that co-manage children in an intensive care unit. Our primary outcomes were learner self-assessment of skills attainmentand workshop satisfaction. We also evaluated the feasibility ofrecruiting busy clinicians. Fifteen clinicians, including eight critical care faculty members (80% of eligible participants), three subspecialty faculty members (100% of eligible participants) and four nurse-practitioners (100% of eligible participants), participated. Learners' self-reported confidence improved in all communication metrics assessed. From pre- to post-workshop, confidence increased from 39% to 94% for 'giving bad news' (p < 0.05), from 50% to 83% for 'conducting a family conference' (p < 0.05), and from 39% to 100% for 'eliciting a family's values/preferences (p < 0.05). Every learner rated the workshop as important to their clinical practice and 100% would strongly recommend it to others. All reported the time commitment was not burdensome and 74% would choose this 2-day format over shorter formats. When clinicians learn together, they are more likely to speak the same language when communicating with each other, and ultimately to deliver the same message to families CONCLUSIONS: An inter-specialty communication training workshop for different types of clinician was well received. It is feasible to co-train different types of clinician in a joint session. When clinicians learn together, they are more likely to speak the same language when communicating with each other, and ultimately to deliver the same message to families.

Enhancing the quality and safety of care through training generalist doctors: a longitudinal, mixed-methods study of a UK broad-based training programme

ObjectiveChanging patient demographics make it ever more challenging to maintain the quality and safety of care. One approach to addressing this is the development of training for generalist doctors who...

Preoperative [99mTc]MIBI SPECT/CT Interpretation Criteria for Localization of Parathyroid Adenomas-Correlation with Surgical Findings.

Minimally invasive surgery for parathyroid adenomas (PTA) requires precise identification and localization of the diseased gland prior to exploration for optimal surgical planning. The Perrier classification allows for accurate, reproducible, and reliable description of PTA location and communication of clinically significant information to surgeons. The current study compares the Perrier localization of PTA on [99mTc]methoxyisobutylisonitrile ([99mTc]MIBI) single-photon emission computed tomography (SPECT)/X-ray computed tomography (CT) with the results of surgery. Eighty-eight patients (60 females), age 13-82years, with primary hyperparathyroidism underwent [99mTc]MIBI SPECT/CT prior to surgery. Eight patients had parathyroid hyperplasia and underwent excision of 3.5 parathyroid glands, including five patients with a negative [99mTc]MIBI study and three patients with multiple foci of uptake, and were excluded from further analysis. Each PTA was localized to Perrier levels A-G. The surgeon located each PTA found on surgery using the same classification. PTA localization on SPECT/CT and at surgery was compared. Eighty patients with surgically confirmed PTA were analyzed. On [99mTc]MIBI SPECT/CT, 63 patients had a single and one patient had two PTAs for a total of 65 PTAs. At surgery, 85 PTAs were resected in 80 patients, including 75 patients with single and 5 with two PTAs. Twenty PTAs found on surgery were not detected on [99mTc]MIBI. The relatively lower weight of these 20 PTAs is probably the main reason for the false-negative results group. The same Perrier localization was determined on SPECT/CT and surgery in 52/65 PTAs (80%). In the 13 incongruent cases, the PTAs were localized at different locations but on the same side of the thyroid gland. [99mTc]MIBI SPECT/CT accurately localized a PTA according to the Perrier classification in 80% of cases. Reporting SPECT/CT results using anatomy-based PTA localization criteria accepted by surgeons can contribute significantly towards better interspecialty communication and will improve performance of minimally invasive surgical removal of PTAs.

Uncovering inter-specialty knowledge communication using author citation networks

Knowledge communication plays a fundamental role in studies of science of science. This paper aims to examine inter-specialty communication patterns within a discipline using author citation networks. Two metrics are designed, including average knowledge flow and average shortest distance. They are used to identify the impact and diffusion characteristics of inter-specialty knowledge communication. We apply these metrics to an empirical data set of Chinese library and information science (CLIS) publications. We find that the two metrics portray different aspects of knowledge communication in CLIS and conclude that indirect paths, the size of specialties, and the communication structure among specialties may lead to the differences.

Practices and education surrounding anticipated periviable deliveries among neonatal-perinatal medicine and maternal-fetal medicine fellowship programs.

To explore national practices of periviable decision-making and care, and to determine and compare trainee education in this domain, within neonatal-perinatal medicine (NPP) and maternal-fetal medicine (MFMP) fellowship programs. A 75-item survey was sent to NPP and MFMP program directors in the United States. In all, 79 of 168 surveys were completed (47%). MFMPs reported offering active interventions for bigger or more mature fetuses (versus NPPs). Variability exists in estimated frequency of simultaneous antenatal counseling by both specialties (range 0 to 90%) and of inter-specialty communication before consultation (range 5 to 100%). One-quarter of MFMPs reported no fellow education regarding periviable deliveries, versus 2% of NPPs (P=0.002); 40% of MFMPs teach fellows about periviable ethics, versus 63% of NPPs (P=0.05). NPPs more frequently utilize role modeling (P=0.01) and simulation (P=0.01) as learning methods. NPPs and MFMPs report different, often asynchronous, practices and fellow education regarding antenatal counseling and resuscitation at periviability.

Exclusion of Residents From Surgery-Intensive Care Team Communication: A Qualitative Study

Communication competency is an important aspect of postgraduate training and patient care delivery in all specialties and clinical domains. This study explored staff surgeon and intensivist perceptions of and experiences with residents' communication with a view toward fostering high quality interspecialty team communication in the surgical intensive care unit. A qualitative study using semistructured interviews. Data were analyzed iteratively and inductively as per standard qualitative thematic approach. University of Toronto, Toronto, Canada. A total of 15 staff surgeons and intensivists who collaborate in patient care in the surgical intensive care unit. The phenomenon of "resident bypass" emerged, resulting from staff surgeon and intensivist perceptions that residents threaten the quality of interspecialty team communication. Clear patterns and preferences for resident exclusion from this communication were present. A total of 5 interrelated drivers of resident bypass were discovered: lack of trust, lack of specialized knowledge, poor system design, need for timely communication, and residents' inadequate contribution to decision-making. Surgical and intensive care staff were dissatisfied with the structure of residents' roles in interspecialty team communication. Concerns about communication gaps, patient care continuity, and patient safety were expressed. Surgical and intensive care staff exclude residents from interspecialty team communication for the benefit of patient safety and care continuity, but this limits opportunities for residents to develop communication skill and competence. Efforts are needed to effectively integrate surgery and intensive care residents in interspecialty attending-resident communication in ways that are meaningful for both patient care and postgraduate training. The implications for medical education are discussed.

Interspecialty communication supported by health information technology associated with lower hospitalization rates for ambulatory care-sensitive conditions.

Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change's Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries with one or more of 4 ambulatory care-sensitive chronic conditions (diabetes, chronic obstructive pulmonary disease, asthma, and congestive heart failure) for whom these physicians served as the usual provider. Key independent variables of interest were physicians' practice capabilities, including communication with specialists, use of care managers, participation in quality and performance measurement, use of patient registries, and HIT use. The dependent variable was a summary measure of ambulatory care-sensitive hospitalizations for one or more of these 4 conditions. Higher provider-reported levels of communication between primary care and specialist physicians were associated with lower rates of potentially avoidable hospitalizations. While there was no significant main effect between HIT use and ACSC hospitalizations, the associations between interspecialty communication and ACSC hospitalizations were magnified in the presence of higher HIT use. For example, patients in practices with both the highest level of interspecialty communication and the highest level of HIT use had lower odds of ambulatory care-sensitive hospitalizations than did those in practices with lower interspecialty communication and high HIT use (adjusted odds ratio, 0.70; 95% confidence limits, 0.59, 0.82). Greater primary care and specialist communication is associated with reduced hospitalizations for ambulatory care-sensitive conditions. This effect was magnified in the presence of higher provider-reported HIT use, suggesting that coordination of care with support from HIT is important in the treatment of ambulatory care-sensitive conditions.

Improving communication between medical and surgical specialists using interspecialty education strategies: A mixed-methods study

Objective: Poor communication between medical and surgical specialists negatively impacts patient care and represents a serious challenge for medical educators. The objective of this study was to measure the effect of a brief interspecialty education program on perceived communication between medical and surgical specialists at a US medical center. Methods: In 2011, an interspecialty education program (“Diagnosing Prosthetic Joint Infections”) was developed and administered by orthopaedic surgery (OS) and infectious diseases (ID) faculty to members of both divisions. The 60-minute program included a review of diagnostics followed by small mixed-group discussions about optimal diagnostic approaches. Surveys (immediately pre- and post-intervention) and a focus group (3 months post-intervention) assessed the impact of the program on interspecialty communication and collaboration. Results: Seventeen OS (41% of whom were trainees) and 13 ID (46% trainee) providers participated. Twenty-nine percent of OS and 62% of ID providers were female. Postintervention, the proportion of participants perceiving that “other” specialty providers were often “effective communicators” (p=0.014) and “effective collaborators” (p=0.025) increased. All participants believed interspecialty education would improve communication. Focus group participants perceived that the program improved interspecialty communication, organizational practice, and patient care. Conclusions: These findings demonstrate that brief interspecialty education programs can improve communication between medical and surgical specialists and could enhance patient care.