Abstract
This quasi-experimental study with two groups examined the effects of face-to-face communication and written communication (documentation review) among OT, PT, and physician assistant students who made discharge decisions for a standardized patient in acute care. The findings advance the knowledge of the influences on effective communication among healthcare teams, how decision making differs between professions, and considerations for curricular planning.
Primary Author and Speaker: Young Joo Kim
Additional Authors and Speakers: Jennifer Radloff, Lynne Murphy, Christine Lysaght, C Stokes, Chia-Cheng Lin
The aim of this study was to examine the effects of face-to-face communication and written communication on discharge decision-making among occupational therapy (OT), physical therapy (PT), and physician assistant (PA) students for a standardized patient in acute care.
Interprofessional communication is a crucial component for improved patient care and health outcomes (Mitchell et al., 2012; Scotten, Manos, Malicoat, & Paolo, 2015); however, the most effective communication method is unknown. The use of standardized patients has shown advantages over case studies in application of learned clinical reasoning (Gillette, Stanton, Rockich-Winston, Rudolph, & Anderson, 2017). Standardized patients can be used to examine effective communication methods among healthcare professionals.
We used a quasi-experimental design with two groups of OT, PT, and PA students.
A total of 26 OT, 27 PT, and 35 PA students at one university were assigned to one of two Groups: Group A (face-to-face communication) or Group B (written communication through note reviews).
In both Groups, students performed an individual, discipline-specific intervention session with a standardized patient in a simulated acute care setting and decided a discharge setting (Time 1). Next, only PA students received a critical message from a family member and again decided a discharge setting (Time 1.1). Then, OT, PT, and PA students in Group A had face-to-face communication together without the patient, whereas students in Group B individually reviewed the other professional students’ notes on their discharge setting decision. Group A and Group B again decided a discharge setting (Time 2). Then, OT, PT, and PA students in Group A and Group B had a team meeting with the patient and decided a discharge setting (Time 3).
We used cross tabulation to describe the changes in discharge decisions by Group and profession and McNemar test to statistically examine the consistency of changes in discharge decisions (nominal data). We used an alpha level of .05 for all analyses.
PA students in both Groups significantly improved their decision after receiving the critical message from the family member (p=.021) (Time 1 to Time 1.1). In Group A, students significantly improved their decision after face-to-face communication (p<.001). Specifically, OT students significantly improved their decision (p=.004) (Time 1 to Time 2). In Group B, students significantly improved their decision after reviewing other professional students’ notes (p=.006). Specifically, OT students significantly improved their decision (p=.016) (Time 1 to Time 2). However, there were no significant differences in decisions between Group A and Group B at Time 2 or Time 3.
Both face-to-face and written communications are effective in improving discharge decisions for acute care patients without significant differences between the communication methods. Different amounts and types of fieldwork experience among professional students may have affected their decision-making process.
In both educational and clinical environments, effective interprofessional communication is vital to facilitate appropriate clinical decision-making. It is important for educators to consider student exposure to clinical settings to improve clinical decision-making. It is important for clinicians to consider how to facilitate effective interprofessional communication, regardless of system constraints.
The outcomes of this study closely relate to Research Priority of “development and transitions for individuals and families”. Effective communications among healthcare professionals can lead to seamless transitions between service settings and affect the resumption of clients’ participation in daily life, health and well-being.
Mitchell, P. H., Wynia, M. K., Golden, R., McNellis, B., Okun, S., Webb, C. E., … Von Kohorn, I. (2012). Core principles & values of effective team-based health care. Washington, DC: Institute of Medicine.
Scotten, M., Manos, E. L., Malicoat, A., & Paolo, A. M. (2015). Minding the gap: Interprofessional communication during inpatient and post discharge chasm care. Patient Education and Counseling, 98(7), 895-900.
Gillette, C., Stanton, R. B., Rockich-Winston, N., Rudolph, M., & Anderson, J. G. Jr. (2017). Cost-effectiveness of using standardized patients to assess student-pharmacist communication skills. American Journal of Pharmaceutical Education, 81(10).