I recently had the following text “conversation” with one of my teenage daughters:
Daughter: Where are you?
Me: In my room. Why?
Daughter: I’ve been yelling for you.
Me (who heard someone yelling but couldn’t understand a word): So why not just come downstairs and talk to me?
Daughter: Never mind.
If you have a teenager, you’ve likely had similar “discussions” that have left you wondering why your child is seemingly incapable of having a normal conversation.
And then it hits you: your kids can’t help themselves because technology has provided so many alternative ways to communicate. Why bother to talk when you can text, email, or Tweet? Old-fashioned conversation – the two-way and in-person kind – has become passé. Text and typing have become the communication means of choice – which is more than sad; it’s quite literally tragic.
The recently released report on the handling of Ebola patient Thomas Duncan at Texas Health Presbyterian Hospital attributes “inadequate communication processes” as one factor contributing to the ED’s failure to diagnose Duncan with Ebola during his initial hospital visit. The expert panel that reviewed the events surrounding the care and ultimate death of Duncan also found that the clinical care team relied too heavily on the EHR to convey critical patient information to other team members.
For example, the panel determined that the care team did not adequately communicate Duncan’s travel history. Though nurses did document in the EHR that Duncan had traveled from Africa, the information was not verbally communicated to other staff. Similarly, a nurse noted a system-generated alert indicating the possibility of sepsis, but failed to verbally share this detail with the physician or discharge nurse.
The panel also cites “challenges” with the hospital’s EHR configuration, which was not set up to “provide for automatic alerts” related to travel history. In fact, “viewing the data would have required a clinician to look beyond the standard patient assessment screen in the EHR to access the travel history from the nursing assessment documentation.” The panel thus raised the larger question of how IT, informaticists, and clinicians in all hospitals could best work collectively to customize EHRs in support of high quality care. One recommendation: conduct an in-depth study that considers the general usability of EHRs, workflows, and care team communications.
The report cites other factors that contributed to the misdiagnosis, including cultural issues, inadequate training, and workflow challenges. While some of the problems were unique to the hospital, the over reliance on technology and the failure to communicate verbally are issues that are far too pervasive across our whole society.
I may shake my head in frustration over my kids’ dependency on their iPhones, yet I must admit that I, too, rely too heavily on technology. I’ve been known to send critical emails without following up to make sure my messages were received and correctly interpreted. Sometimes picking up the phone and talking can be a chore, but old-fashioned conversation minimizes the chance that one’s message will be missed or misinterpreted. And when the message is critical, nothing beats a face-to-face discussion.
Do you agree? Want to talk about it?
Michelle Ronan Noteboom
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