From the 2024 HVPA National Conference
Marah Hamdan BS, MD (Lehigh Valley Health Network Department of Surgery), Timothy Graziano DO (Lehigh Valley Health Network Department of Medicine), Kathryn Zaffiri MPH, Terri Vian MS, Amy Slenker MD, Jason Weinberger MD
Background
Effective collaboration between specialties is essential to optimize patient care. Moreover, the failure to recognize a surgical emergency and promptly refer to the appropriate team can precipitate poor outcomes. The effects of interdisciplinary communication and teamwork on patient outcomes have both been well-studied: some reports highlight perceptions of hierarchy and accessibility as key barriers, particularly in the setting of different specialty disciplines and training experiences.
Objective
This quality intervention explores perceptions of the surgical triage process and how misconceptions can lead to detrimental delays in patient care. Strategies to evaluate and promote clear, effective interspecialty communication were also identified.
Methods
A pre-intervention survey was issued to Internal Medicine (IM) residents assessing their confidence and ability to contact appropriate on-call surgical team members. Immediately following completion of this survey, residents participated in a didactic series on surgery resident call schedules and various channels to communicate with surgical teams throughout the workday. A brief review of acute surgical emergencies and approaches to initial management was included. Residents were then invited to participate in an open discussion about their personal experiences consulting surgery teams and potential strategies to minimize communication barriers. Approximately 6 weeks afterward, a post-intervention survey was distributed reexamining IM residents’ experience and confidence in the reviewed topics. Pre- and post-survey responses were incorporated into a secure Excel spreadsheet.
Results
Questions assessing IM residents’ comfort with contacting surgical teams were evaluated with non-paired t-testing. There was a statistically significant increase in IM resident comfort level with locating appropriate on-call surgical team members for both routine and STAT consults. However, there was no significant difference in the level of comfort with contacting a surgical consultant. Of note, a majority of participating IM residents found a discussion on surgical emergencies informative and worth repeating annually. They also felt an interspecialty discussion is valuable to facilitate both patient management and consultant collaboration. Finally, residents identified a strong preference to be informed of surgical recommendations by multiple avenues, including direct messaging.
Conclusions
Streamlined interdisciplinary communication is crucial to patient safety. Variations in medical background and training culture can augment barriers to communication and in turn affect patient outcomes. Therefore, it is important to elucidate and address knowledge gaps in surgical emergencies and highlight areas of communication misconception.
Clinical Implications
This project generated a productive, replicable discussion to address these items with the goal of minimizing delays in patient care.