Patterns of Nurse‐Physician Communication and Agreement on the Plan of Care

Background:

Interdisciplinary communication is critically important for safe and effective patient care. Little is known about patterns of communication between nurses and physicians caring for hospitalized medical patients. Our objective was to characterize nurse‐physician communication and agreement on the plan of care (POC).

Methods:

During the 1‐month study period, 342 randomly selected hospitalized medical patients and their nurses and physicians were interviewed. Interviews were conducted in the afternoon of patients' second hospital day. Each nurse was asked to identify the primary physician taking care of the patient, whether communication with this physician had occurred, and the nurse's understanding of the POC in 6 areas: main diagnosis, planned tests, procedures, medication changes, which consulting services were expected to see the patient, and the expected length of stay (LOS). Each physician was asked to identify the nurse, whether communication had occurred, and about the 6 areas of the POC. Two internists rated nurse‐physician agreement on aspects of the POC as no agreement, partial agreement, or complete agreement. Measures included the percentage of nurses and physicians able to identify one another and reporting communication, and the percentage of nurse‐physician pairs in agreement on aspects of the POC. A nurse‐physician summary agreement score was calculated by assigning 0, 1, or 2 points for no, partial, or complete agreement for each aspect of the POC (score range 0‐12).

Results:

Three hundred and ten (91%) and 301 (88%) of 342 eligible nurses and physicians, respectively, completed interviews. Nurses correctly identified physicians 71% of the time and reported communicating with physicians 50% of the time. Physicians correctly identified nurses 36% of the time and reported communication with nurses 62% of the time. Nurses and physicians showed poor agreement in all 6 areas of the POC. There was no agreement between nurses and physicians on planned tests or procedures for the day in 11% and 26% of instances, respectively. Complete agreement on the expected LOS occurred only 33% of the time. There was no difference in the nurse‐physician summary agreement score based on whether communication had occurred (7.63 vs. 7.78, P = .67).

Conclusions:

In our study sample, nurses and physicians did not reliably communicate with one another and were often not in agreement on the POC for hospitalized medical patients. Future research should test interventions to improve communication and create a shared understanding of the patient POC.

Author Disclosure:

K. O'Leary, none; M. Landler, none; N. Kulkarni, none; C. Haviley, none; Jason A. Thompson BA, none; K. Hahn, none; J. Jeon, none; D. Wayne, none; D. Baker, none; M. Williams, none.