Standards of Communication in Medical Settings
The standard of communication in medical settings should utilize structured tools such as SBAR (Situation, Background, Assessment, Recommendation) or SAED (Situation, Antécédents, Évaluation, Demande) to ensure clear, concise, and exhaustive information exchange that improves patient safety and reduces adverse events. 1
Structured Communication Tools
Closed-loop communication, where verbal repetition confirms understanding, improves team efficacy in critical situations and reduces medical errors, particularly in specialized settings such as pediatric trauma resuscitation 1
SBAR (Situation, Background, Assessment, Recommendation) and its variants like SAED in France and SCAR (Situation, Context, Appreciation, Recommendation) in Switzerland serve as mnemonic devices that structure oral communication, improving teamwork and safety climate while reducing unplanned intensive care admissions 1
"Speaking up" is essential in crisis situations, allowing team members to express concerns assertively without fear, particularly when in subordinate positions, which helps prevent adverse events 1
Systematic cross-checks during patient management have been shown to reduce adverse events by 40% in emergency settings (90 events in non-cross-check group vs. 54 in cross-check group) 1
Communication During Critical Situations
Information-sharing at key moments through checklists has demonstrated reduced perioperative morbidity and mortality, highlighting the importance of structured communication during critical phases of care 1
Standardized handover processes with targeted checklists have been shown to reduce hypoxemic events in post-anesthesia care, particularly when including items that encourage questions and confirmation of comprehension 1
Positive communication behavior during handovers improves team performance in subsequent crisis situations, emphasizing the connection between effective communication and patient outcomes 1
Simulation-based closed-loop communication training can significantly reduce medical errors and improve management time in critical situations such as cardiac arrest 1
Team-Based Communication Approaches
Setting a tone of mutual respect and "psychological safety" by calling team members by name and inviting their input improves staff satisfaction, decreases turnover, and creates a safer environment for patients 1
Critical language skills help prevent procedure-related errors by establishing consistent phrases (such as "I need clarity") that signal potential adverse events without disrupting care 1
Crew resource management (CRM) principles, adapted from aviation settings, focus on teachable team communication and coordination behaviors that have been shown to improve safety in high-risk environments 1
Interdisciplinary team training programs incorporating proven methods for team management are recommended to improve communication and patient safety 1
Communication with Patients and Families
Patient- and family-centered care requires mutually beneficial collaboration between patients, families, and healthcare professionals, though challenges exist in emergency settings due to lack of previous relationships 1
When delivering bad news, physicians should ensure uninterrupted time in a private location, use lay language, speak in small chunks, adjust pace to the patient's understanding, and probe for comprehension 1, 2
Physicians should acknowledge and name emotions when patients or family members display them, and be cautious about providing additional information when patients are in a highly emotional state 2
Electronic communication with patients should only occur after discussion and previous agreement, with appropriate security measures in place to ensure patient confidentiality 1
Common Pitfalls and How to Avoid Them
Poor communication is the underlying problem in most medical-legal cases, with the majority of negligence cases triggered by inadequate communication rather than clinical quality of care 3
Avoid information overload by breaking information into manageable pieces and don't rely solely on medical jargon when communicating with patients 2
Don't assume conversations will follow a linear script; be prepared to adapt to the nonlinear, unscripted nature of medical interactions, particularly when delivering bad news 2
Avoid making assumptions about what constitutes "bad news" for a particular patient, as what seems minor to healthcare providers may be devastating to patients 2
Impact on Patient Safety
Poor communication contributes to 24.0% of patient safety incidents alongside other causes, making it a major factor in adverse events 4
Effective communication is not only essential for accurate history-taking but also helps patients understand their illness and assists the healing process 3
Communication breakdowns between doctors and patients often occur before incidents that lead to claims, suggesting that building rapport early can reduce complaint likelihood 3
Recent systematic review evidence indicates that poor communication is the sole cause of 13.2% of safety incidents, highlighting its critical importance in healthcare settings 4