New $1.6 million grant will investigate nurse and physician communication
Julia Adler-Milstein, assistant professor in the School of Information and the School of Public Health, will serve as a co-investigator on a $1.6 million grant from the federal Agency for Healthcare Research and Quality (AHRQ) that will investigate how communication technologies such as health records, email, and pagers are being used and where common failures occur.
The project will be led by Milisa Manojlovich, PhD, RN, CCRN, a U-M School of Nursing (UMSN) associate professor and member of U-M’s Institute for Healthcare Policy and Innovation.
“Communication technology can increase or reduce adverse effects for patients depending on how nurses and physicians are using it,” Manojlovich said. “Unfortunately, communication failures are one of the most common causes of adverse events for hospitalized patients, so it is very important to understand how communication technology is being used and how it can be improved."
Manojlovich pointed out that as electronic communication has increased, the face-to-face communication between practitioners has decreased, which has led to instances of crucial information being passed along incorrectly or not at all.
“The work environment and policies are often not conducive to effective communication,” Manojlovich said. “For example, in a previous study, we observed physicians place a STAT order, meaning immediately, in the computer. However, they would not notify the nurse in any other way. The physicians were not aware that by hospital policy, nurses were only required to check the computer for orders every two hours.
“That meant that a STAT order sometimes went almost two hours before it was acknowledged and acted upon by the nurse,” she explained. “It is not about blame because both the doctor and nurse did their job properly according to policy, but this communication failure can have serious implications for the patient.”
Adler-Milstein and fellow researchers will use a sequential mixed methods design including surveys, telephone interviews, observations, shadowing, and focus groups at hospitals across the country to learn how communication technologies, communication practices, and work relationships affect communication. The research team plans to use these results to make recommendations for design configurations that will improve the functionality of health IT.
Manojlovich stressed that this study is designed to foster improved and positive interdisciplinary communication and team-based care. In keeping with AHRQ’s interest in health IT, this study will identify communication technologies that support mutual understanding of information between nurses and physicians. In addition, the researchers aim to recognize how problem recognition, identification, and diagnosis can occur more rapidly and accurately, possibly reducing risks to patient safety.
Working with Adler-Milstein and Manojlovich on this project are the following co-investigators:
- Molly Harrod, PhD, Research Scientist at the VA Ann Arbor Center for Clinical Management Research
- Timothy Hofer, MD, MSc, Professor of Medicine, University of Michigan Medical School and Research Scientist at the VA Ann Arbor Center for Clinical Management Research.
- Sarah Krein, PhD, RN, Research Scientist at the VA Ann Arbor Center for Clinical Management Research and a Research Associate Professor, Department of Internal Medicine at the University of Michigan.
- Sanjay Saint, MD, MPH, Professor of Internal Medicine at the University of Michigan and a Research Investigator at the Ann Arbor VA Center for Clinical Management Research.
- Anne Sales, PhD, RN, Professor of Nursing, University School of Nursing and Research Scientist at the VA Ann Arbor Center for Clinical Management Research.