Interdisciplinary communication: an uncharted source of medical error?

Medi cal error and patient safety have become importan tissu es and are report ed to be the 8th leading cause of deathamong Am ericans [1] . There is a growing unders tandi ngthat the clin ical envir onmen t and clinical proces sesNn otindi vidual clinicia nsNar e the maj or contr ibutors to medicalerror . The purpos e of our analys is was to focus on oneaspect of the syste ms approac h to error Nthe role of poorcomm unication among clinical discipli nes as a cause ofmedi cal error .Organizations such as hospital s are comple x structure sthat use a mul tilayered approac h to comm unication. Pagingsyst ems, telep hones, e-ma il, fax, and face-t o-face inte r-actions are but a few of the modes of commun ication thatmedi cal provi ders use in carin g for their patients. Thisbcomm unication space Q is huge in terms of both the totalinfor mation transaction s and the clin iciansN bthe bigges tinfor mation reposi tory in health care lies in the peoplewor king in it, and the biggest informat ion system is thew eb of conversations that link the actions of theseindi viduals. It is throu gh the multitude of conversati onspepperi ng the clin ical day that clin icians exa mine, presen t,and inte rpret clin ical data and ultima tely decide in clinicalactions Q [2] .People ha ve been point ing out the existence of poorcomm unication in clinical practice for years. A report 25years ag o su g gested th at 1 5% of h um an error w asattributable to commun ication problems [3] . The HarvardMedical Practice Study [4] , the Qual ity in Australian HealthCare Study [5] , and the Inst itute of Medicine report [1] allrevealed that ineffective comm unication is a signi ficantfactor in medi cal erro r. Researche rs in family pract ice [6] ,emergency medicine [7-9] , anest hesia [10] , an d the inten-sive care unit (ICU) [11] all make pleas for better teamcom m unication. N um erous case reports and editorialsstating that good comm unication is param ount and that allefforts shoul d be made to imp rove communi cation havesurfaced emphatically [12-24 ]. Reg rettabl y, there is neitheran adequat e defin ition of good comm unication nor anattempt to quantify communi cation as meeting min imalcriteria for effectiveness . Indeed, very limit ed resear ch onwhat type of comm unication actually occurs betw een healthprofession als exists.