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Communication problems often contribute to untimely care of acute infections in nursing homes

Quick diagnosis and management of acute infections among nursing home residents require successful communication at multiple levels. However, communication breakdowns are common, and they create barriers to timely care of acute infections in nursing home residents, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08551). Researchers from the University of Missouri-Columbia analyzed discussions of focus groups of nursing home physicians and nurses and interviews with nursing home residents, nurses, and physicians involved in acute illness care. Their goal was to identify factors that promoted or delayed timely identification and treatment of residents' acute infections.

The interviews revealed 22 factors that influenced timeliness of effective care, with communication problems commanding the central focus. Six communication barriers stood out: failure of the physician to receive a message; evening or weekend illness onset, problems in contacting the on-call physician; reliance on an intermediary (for example, an office nurse) to convey orders from the physician; communication of inappropriate or inaccurate information; inadequate information transfer between nursing staff at shift changes; and a nurse's reluctance to talk with a physician perceived as difficult.

Focusing on these communication barriers may improve quality of care for acute infections in nursing home residents, suggest the researchers. More effective teamwork between physicians and nurses can improve care and avoid residents being unnecessarily transferred to the hospital for the treatment of acute illnesses. This approach could also save health care costs by intervening earlier in the causal chain that leads to hospitalization and poor outcomes in acute illness among nursing home residents.

See "Barriers to timely care of acute infections in nursing homes: A preliminary qualitative study," by Daniel R. Longo, Sc.D., Jake Young, M.A., David Mehr, M.D., M.S., and others, in the March 2004 Journal of the American Medical Directors Association 5, S5-S10.

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