Background: Studies show that nurses and physicians often have different perceptions of the quality of interprofessional communication. An important part of daily communication between physicians and nurses involves patients’ clinical plan of care for each day (‘care plan’). We conducted a study examining hospitalist and nurse perceptions of communication of shared patient care plans.
Methods: As part of a quality improvement initiative at a large, urban academic medical center, we conducted written and verbal surveys with hospitalists and medicine unit nurses about whether care plans were communicated for specific patient encounters and elicited other general feedback on interdisciplinary communication. We evaluated rates of care plan communication as reported by hospitalists and nurses. We performed a thematic analysis of qualitative responses to identify factors contributing to discrepancies in hospitalist and nurse perceptions of care plan communication.
Results: 48 nurses and 30 hospitalists provided survey responses for 123 and 132 patient encounters, respectively. Of the 255 total survey responses, we had matched responses from hospitalists and nurses for 59 patient encounters. There were consistent discrepancies in perceptions of care plan communication between hospitalists and nurses (Figure 1). Hospitalists generally responded that they communicated a care plan more often than nurses reported receiving care plan communication. For matched patient encounters, in all instances of disagreement (14%, 8/59), the hospitalist reported that a care plan was communicated while the nurse reported they did not receive care plan communication. Qualitative feedback highlighted potential factors contributing to this discrepancy. First, nurses often associated the term ‘care plan’ specifically with a discharge plan, whereas hospitalists did not. Second, discrepancies in care plan communication occurred when the physician perceived the patient’s plan as simple or a continuation of the previous day’s plan and provided an update that was not perceived as a care plan by the nurse, possibly due to brevity or omitted details. Third, in some cases, perceptions differed when physicians and nurses communicated regarding daily care needs that were not contextualized within a broader treatment plan. Fourth, discrepancies occurred when information was not perceived as relevant or actionable by nurses.
Conclusions: In matched patient encounters, we found discrepancies in reported rates of care plan communication with hospitalists reporting they communicated care plans more often than nurses reported receiving this communication. We identified multiple factors contributing to this discrepancy and our results suggest that future initiatives to improve care plan communication should focus on establishing shared expectations between physicians and nurses, ensuring the consistent delivery of care plan communication regardless of clinical complexity, and contextualizing actionable daily updates within the broader treatment plan.
