Communication and older people in hospital

By communicating effectively with patients we can find out what matters to them and tailor care to meet their needs and wishes.

Communication is a ‘procedure’ in good clinical care¹ that we can use to improve our patients’ experience and their participation in care. This will help minimise their risks of functional decline in hospital.

Like wound care or surgical procedures, we need to learn and practise good clinical communication skills.¹

Every interaction we have with our patients, their family and carers, and our colleagues requires us to draw on our communication skills. This includes screening, assessing, developing and delivering intervention and discharge plans, and providing safe and effective clinical handover.

This topic gives an overview of communication and recommends actions that we and our organisations can take, in addition to health service policy and procedures, to communicate effectively with our older patients.

Purpose

During their stay in hospital, people often require care from many clinicians; they may move wards and their care plans may change. This can cause stress, particularly in older patients. We can use communication to reassure patients, alleviate their fears and develop a partnership to reach the best possible outcomes^.

We can think of communication as a ‘procedure’² that we use to encourage patients to participate in their care. We know from the feedback received by hospitals, that communication and the quality of our interactions are very important to our patients. Older people remember how we made them feel during their hospital stay and not necessarily what we did. We also know that failures of communication and teamwork can play a role in avoidable adverse events in hospitals.

Elements of communication

Communication is more than information exchange, it includes the subtle ways we interact and how we use and respond to verbal and non-verbal cues^2,3. Often, communication is about being curious, observing your patient and, most importantly, listening and responding to their concerns.

Communication is the interplay of many elements including:

• language and speech
• eye contact
• body language, gestures and postures
• facial expressions
• active listening
• empathy
• touch
• distance from the person
• voice quality, rate, pitch, volume
• communication tools and frameworks
• written aids
• communication aids (for example, interpreters, hearing aids, glasses)
• identifiers such as red trays, the cognitive identifier, falls risk signs to indicate a prevention plan is in place to staff and patients
• health system design
• health system roles, hierarchies and teamwork.

Effective use of these elements encourages older people and their families and carers to participate in their care.

Communicating effectively

Effective clinical communication is about building a relationship, providing and sharing information, and sharing decision-making. Here are some things we can do to communicate effectively with our patients.

Communicating with team members

As clinicians we communicate with other clinicians in person, in the patient record, in handover documentation and in other charts. We also have discussions during ward rounds, in meetings with treating team members, at handovers, and in informal conversations. All of these tasks require skilful clinical communication⁷.

Teamwork impacts on patient wellbeing

A supportive health service team culture has been associated with higher functional wellbeing for patients post discharge².

Communication is a critical element in effective teamwork. A well-functioning team fosters an environment where we can ask questions and be ‘respectfully assertive’ with other team members, no matter the role or position, whenever a patient appears at risk^3,4. Good team member communication processes support clinicians, translating into better individual interactions.⁵

Effective teamwork does not just happen; it requires skill development, practice and a supportive environment. Excellent individual skills do not guarantee effective team performance in delivering care^4,6.

Team meetings

Team meetings can be used effectively to organise and learn⁶. Even brief one to five minute team meetings at handovers (and within shifts if required) to assess and organise are important⁴.

Items to address in team meetings to improve patient care include:

• identifying team members and leaders
• establishing or re-establishing situational awareness
• assigning or re-assigning responsibilities and tasks
• making team decisions
• discussing problems
• reviewing lessons we have learned.^{4, 6}

Teamwork actions

Individual teamwork actions are the most common teamwork activities. Failures in four individual teamwork actions have been most implicated in medical errors⁴. The following are the four clinical teamwork skills that most reduce medical errors:

1. Know what protocol or plan is being used. This should be clear to everyone on your team.
2. Advocate for your patients. Assert your opinion or a correction to team members if you believe a patient is at risk. Leaders have a responsibility to create an environment where this is possible.
3. Understand the care plan and prioritise tasks for your patients accordingly.
4. Cross-monitor the actions of team members for simple errors and act to correct if required. Leaders should create an environment where this is an acceptable practice.

Documentation

Documentation helps us monitor interventions to minimise functional decline in our patients and communicate with the team.

In addition to following local documentation policy and procedures, consider the following actions to provide the information needed by the team⁷.

Record observations and actions accurately; clearly state the facts, what you saw, heard, smelt, felt and did.

• Record enough information so that another clinician can continue care, include what preceded an event or change in care if that information is relevant to continuing care (for example, if a code grey is called for an older person with dementia, the events preceding the code grey are important for other clinicians to know how to deliver safe and effective person-centred care).
• Document information about medications completely. Write medication names in full.
• Document every assessment while the older person is in your care. This establishes a baseline, a record and a timeline of the person’s health.
• Document as soon as possible to ensure important details are recorded and facts are not lost or shaded by subsequent events. Timely documentation also aids in treatment.