Picture this: Your best friend has been injured in a car accident in a rural area. You manage to safely and successfully get her to the nearest rural hospital and discover that a transfer to a major trauma hospital is needed.
Within trauma medicine there is a concept called “the golden hour” — patients treated within the first hour of injury have a mortality rate of 10 percent. That jumps to 75 percent if the treatment occurs within the first eight hours. Rural patients are already at a disadvantage because of distance and terrain, but poor communication between staff at a rural hospital and staff at the trauma center can also lead to increased transfer times, and time is a critical factor in patient survivability.
The Accreditation Council for Graduate Medical Education identifies communication as one of the six core competencies that post-MD medical training students must exhibit in order to graduate. Recently a team of researchers at West Virginia University undertook an experiment to observe the effects of a one-hour addendum to the Rural Trauma Team Development Course. The addendum focuses on streamlining information transfer and quality communication between Level 3, 4, and 5 rural hospitals and Level 1 and 2 trauma medical personnel.
The Rural Trauma Team Development Course teaches health care providers at rural hospitals to identify injuries requiring transfer within the first 15 minutes and effectively communicate the key issues to the Level 1 or 2 center when they call for transfer. The WVU School of Medicine funds the course and donates its faculty time.
A recent collaboration between faculty in the Department of Communication Studies and the School of Medicine has resulted in improvements in the protocol that successfully reduces transfer times between rural facilities and larger trauma centers by 40 minutes. The improvements have been adopted as the new standard for the American College of Surgeons, an organization of over 73,000 physicians around the world. This new standard trains Level 3, 4, and 5 trauma personnel in effective and affirming communication.
Matthew M. Martin, Ph.D., professor and chair of the Department of Communication Studies; Theodore A. Avtgis, Ph.D., associate professor of communication studies and adjunct associate professor of surgery; E. Phillips Polack, M.D., clinical professor of surgery at WVU, and Daniel Rossi, D.O., a former surgical resident at WVU, found problems encountered during the patient transfer process from rural facilities to major trauma centers included hostility, condescension, and dismissive behavior. Conversely receiving level 1 and 2 trauma centers reported wasted time due to ineffective communication and extraneous information from the staff at the smaller facilities.
“Doctors and personnel at larger trauma centers were engaging in behavior that caused their counterparts at the rural facilities to become angry, defensive, and frustrated,” said Avtgis.
“They were second-guessing diagnoses and asking a number of redundant questions in ways that were adversely affecting the teamwork and coordination necessary to treat patients in effective and timely ways. Level 1 and 2 trauma center personnel were frustrated by the quality and type of information provided by their rural counterparts. The lack of mutual respect was eroding effective communication and information exchange.”
Avtgis and Martin attribute this type of breakdown to the tendency for relational and personality factors of the healthcare team to adversely influence efficient and effective information transfer. They say that the same types of breakdowns can happen in any organization.
“You can have the best and most highly trained medical personnel out there, but transfer is about logistics, it’s about communication. That is why this multidisciplinary approach gets results. It combines excellent medical care with excellent communication,” said Avtgis.
To address a breakdown, Polack administered communication training, designed by Martin and Avtgis, to personnel in Level 3, 4, and 5 medical facilities throughout West Virginia. The training consists of a 30-minute lecture on communication competence and 30 minutes of role playing with the participants. The team found that the communication training significantly reduced the amount of time it took the smaller hospitals to decide to transfer a patient, the time it took for a transfer squad to arrive, and the number of squads contacted before finding one to transfer the patient.
Facilities with no RTTDC training had a 77 minute transfer time, facilities with the medical portion of the training showed a 67 minute transfer time. Those with both the medical and the communication training showed a 37 minute transfer time.
“Hospitals can spend enormous amounts of money on technology to reduce transfer times with limited success. By focusing on concise and competent communication we have an inexpensive and incredibly effective training which based on our findings, yields benefits for both the patient and healthcare practitioners,” said Martin.
“West Virginia University is consistently the benchmark of excellence and an incubator for unique and effective solutions in the area of rural medicine and health communication. Adoption of this new protocol by ACS is yet another indication that the collaborative academic work done at WVU saves lives and improves communities.”
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