Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System.
Am J Crit Care. 2019 Jul;28(4):290-298. doi: 10.4037/ajcc2019372.
Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians.
To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters.
Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital. Common themes were identified, analyzed, and then organized using a conceptual framework of contextual barriers to communication: organizational, cognitive, and social complexity.
Several barriers to communication between physicians and nurses contributed to inappropriate use and delayed removal of catheters. Workflow misalignment between clinicians was a barrier associated with organizational complexity, issues with electronic medical records and pagers were associated with cognitive complexity, and strained relationships between clinicians and rigid hierarchies were associated with social complexity.
Communication is contextual, and improving physician-nurse communication about appropriate catheter use may require innovations that address the identified contextual barriers.
留置导尿管和血管内导管是导致医疗保健相关性感染的常见原因。如果干预措施不能融入忙碌临床医生的工作流程和沟通流程，那么减少导管使用的干预措施可能无效。
描述医生和护士之间的沟通障碍，并了解这些障碍如何影响留置导尿管和血管内导管的合理使用和拔除。
对学术医院的一个渐进护理病房的医生和护士进行了个人和小组半结构化访谈。确定、分析了共同主题，然后使用沟通的上下文障碍的概念框架（组织、认知和社会复杂性）对其进行了组织。
医生和护士之间的沟通障碍导致了导管的不适当使用和延迟拔除。临床医生之间的工作流程错位与组织复杂性有关，电子病历和寻呼机方面的问题与认知复杂性有关，临床医生之间的紧张关系和僵化的等级制度与社会复杂性有关。
沟通是有上下文的，要改善医生与护士之间关于适当使用导管的沟通，可能需要创新措施来解决已确定的上下文障碍。
