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Failures of communication

Underpinning good patient care is good communication, and this goes beyond establishing good relations with patients. In today’s team approach to delivering healthcare, communication has to extend to more people and there are therefore more opportunities for it to fail.

Communication between primary care, secondary care and social and voluntary services should be seen not as a chain, but as a communication net, within which any one member may need to communicate with any other (see Figure 1; page 41). Good management requires all members of the communication net to be conscious of who is doing what – an adequate standard of continuing medical care can be achieved only if all participants – both medical and non-medical – understand their roles.

Keeping people informed in the interests of continuity of care must be balanced against the need to maintain confidentiality, and both these issues should be borne in mind when sharing relevant information about patients. Unless the patient asks you not to, it is entirely appropriate to share information about patients with people involved in their care.

Case report: Dual system causes communication breakdown

Mr A, a 67-year-old hotelier, was referred to A&E with a suspected transient ischaemic attack. He was seen by Dr K, the junior doctor on duty, who arranged a CT scan for the following morning.

Mr A was transferred to a medical ward for observation overnight and the scan was performed later the next day by Dr E, the radiologist on-call. Dr E was not able to report the scan straight away, but Mr A was told that he could go home and that his GP would be contacted in due course with the result of his tests.

Two weeks later, Mr A was found collapsed in the hotel dining room. He was readmitted to A&E where an emergency CT scan showed a large cerebellar tumour with evidence of recent haemorrhage. There were signs of ventricular dilatation and raised intracranial pressure. Unfortunately, Mr A died before he could be transferred to a neurosurgical centre for specialist treatment.

It later came to light that no-one on the ward had followed up Mr A’s first CT scan, which showed a mass in the cerebellum that the radiologist reported as “consistent with a primary or secondary neoplasm”. At the time, the hospital had been operating a mix of electronic and paper records. The radiologist had lodged his report in the electronic system, but this had not been transferred to the patient’s case notes, which had been filed away after the patient’s discharge.
At the time, the hospital had been operating a mix of electronic and paper records