In the past seven years, healthcare miscommunication has cost over $1.7 billion in additional medical expenses, and over 1,700 lives. According to research from research/analysis firm CRICO Strategies, communication problems were a contributing factor in 7,149 cases (30 percent) of 23,000 medical malpractice claims filed between 2009 and 2013. Obviously, the statistics are only a fraction of the total number of medical malpractice incidents that did not lead to lawsuits.
Common breakdowns in communication include miscommunication about a patient’s condition, inadequate informed consent, poor documentation and an unsympathetic response to a patient’s complaint. Patient safety advocates have pushed for improved healthcare communication for decades, spurred by the 1994 death of a Boston Globe reporter from a chemotherapy overdose. The numbers in the CRICO report indicate disappointingly little progress on the issue in the intervening years, according to Frank Federico, vice president for patient safety at the Institute for Healthcare Improvement. “We’ve been working on this for a long time, and it still continues to be a big problem,” Federico told STAT.
The report includes several examples, including a situation in which one man died after a nurse noticed, but failed to alert the surgeon that the patient was experiencing signs of internal bleeding. Another case involved a diabetic patient who collapsed and died after staff at a medical practice failed to give the primary care provider telephone messages from the patient. In a third case, a woman asked to have her tubes tied after delivering a baby through a C-section, but her instructions were not shared with the obstetrician on duty. The patient filed a malpractice claim when she got pregnant again.
The report cites many challenges to healthcare providers, such as heavy workload, hierarchical workplace culture, cumbersome electronic health records, and constant interruptions. And it highlights solutions, including a program called I-PASS born at Boston Children’s Hospital.
The report also had disturbing findings with electronic medical records (which we have written about previously). While EMRs have emerged partly to improve incidents of healthcare miscommunication, in some cases they have the opposite effect. For instance, one woman’s cancer diagnosis was delayed for an entire year because her lab result was plugged into the electronic health record but was not flagged to her primary care provider.
In another case, a primary care provider referred a patient to a lung doctor but didn’t mention lab results signaling possible early congestive heart failure, assuming that doctor would see the results in the electronic medical record. About nine days later, the patient was rushed to the emergency room and died after his lungs filled with fluid.