When critical information emerges or there is a risk to patient care, timely communication of this information to the appropriate person(s) is essential to ensuring patient safety and delivery of the right care.
How critical information is defined in an organisation will depend on the type of services provided and the needs of the local population using the service. It may be helpful to consider what clinical and non-clinical information is time critical or significant to patient care, such as:
New critical diagnostic or test results that require a change to care
Changes in a patient’s physical and psychological condition, including unexpected deterioration or development of complications (linked to the Recognising and Responding to Acute Deterioration Standard)
Errors in diagnosis
Missed test results
Predetermined alerts and triggers
Follow-up communication following a review of results.
This criterion recognises that critical information can arise at any point during a patient’s care. These times can occur outside formal clinical handover and can be closely linked to the formal processes of recognising and escalating acute deterioration, if escalation is required.
This criterion is closely linked to clinical handover (Action 6.8) and recognising acute deterioration (Detecting and recognising acute deterioration, and escalating care and Responding to acute deterioration). It addresses a communication gap by ensuring that the ‘in-between times’ are captured and that organisations have systems and processes in place to support communication of critical communication, whenever it emerges or changes. This is essential because problems in communication at in-between times can result in failure to rescue, inappropriate treatment, care that does not align with a patient’s goals or preferences, and poor coordination of care.1, 2
New critical information can come from several sources, including patients, carers and families.
For timely action to occur, information must be communicated to the right person – that is, a clinician(s) who can make decisions about care. It is important to decide who this is, and to have processes that enable the workforce, patients, carers and families to know who this person is at any given time. What is ‘timely’ will depend on how important or time critical the information is to a patient’s health, wellbeing or ongoing care. For example, communication may need to occur immediately, within hours or within days.
This standard does not apply to all informal communications. The intention is for organisations to consider and define what critical information means for their particular service, and put in place formal processes to ensure that this critical information is communicated whenever it emerges or changes. Ensure that policies and processes include:
When communication should occur (for example, flags, triggers, alerts, defined criteria or critical values for diagnostic tests, referral criteria)
Expectations about the time frame in which communication should occur (emphasising timely communication that is relevant to the criticality of the information)
Who to communicate with and how to escalate in the event of no response
The preferred method of communication.
Documenting critical information in the patient’s healthcare record is also essential to ensure patient safety and to support subsequent communications and decisions about care. It is therefore important to consider the requirements under Action 6.11.
In developing processes, consider ways to support closed-loop communication. This is when the person who is communicating the information knows that the message has been received and there is a response that lets them know that action will be taken to deal with the communication need. Closed-loop communication is especially important if communication occurs through tools or technologies that do not allow two-way communication, such as pagers, email or letters.
- Wu R. Turning the page on hospital communication slowly [editorial]. BMJ Qual Saf 2017;26:4–6.
- Johnston M, Arora S, King D, Stroman L, Darzi A. Escalation of care and failure to rescue: a multicenter, multiprofessional qualitative study. Surgery 2014;155(6):989–94.