Communicating for safety

Healthcare services in primary and community settings often see patients on a regular basis and establish rapport and professional relationships over extended periods of time. However, where healthcare providers are unfamiliar with a patient, or in certain high-risk scenarios, patient identifiers should be used to help ensure correct care is delivered. 

Patient identifiers are items of information that can be used to confirm a person’s identity. There are a range of patient that can be used. Some examples include:

• Legal name
• Preferred or affirmed name
• Date of birth
• Sex
• Gender
• Address (including postcode)
• Healthcare record number
• Last three digits of a patient’s phone number

Healthcare services should determine patient identifiers that will be most appropriate in their service context, and consider the privacy implications when adopting a particular method. Using at least three patient identifiers reduces the risk of incorrect identification.⁴⁸

When patients are known to the healthcare service, periodic confirmation of identity may be appropriate, for example, “Do you still live at… I’d like to check that we have the correct details on record”.

Links to Action 3.26 Processes for effective communication.

• Define a process for the reliable and correct identification of patients when health care, medicine, therapy and other services are provided
• Agree a list of patient identifiers that can be used by the workforce

• How does the workforce confirm a patient’s identity before providing care? 
• What patient identifiers are used to confirm the identity of a patient?

• A documented process for patient identification
• Documentation on the agreed patient identifiers to be used
• Observation of the patient and procedure matching process
• Templates, checklists or documentation identifying and matching a patient to their intended care - for example, patient registration forms and healthcare records
• Communication materials or training records for the workforce on correct patient identification.

Australian Commission on Safety and Quality in Health Care: Communicating for safety resource portal. Provides practical support for implementation of the communicating for safety actions in the National Safety and Quality Health Service Standards. Resources are therefore primarily relevant in acute settings; however the principles and strategies outlined in these resources are broadly applicable.

Australian Bureau of Statistics. Standards for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables. Developed to support the standardisation of the collection and dissemination of data relating to sex, gender, variations of sec characteristics and sexual orientation.

By using patient identifiers required in Action 3.25 Processes for effective communication, healthcare services should correctly match a patient to their care. This process should occur at occasions that require three approved identifiers to be used. These are:

• When a patient is unknown to the healthcare provider
• Before health care is delivered
• When making a referral to another healthcare provider.

Documentation is an essential component of effective communication. Given the complexity of health care, healthcare records are amongst the most important information sources available to healthcare providers. Undocumented or poorly documented information relies on memory and is less likely to be communicated and retained. This can lead to a loss of information, which can result in misdiagnosis, errors and patient harm.

Documentation can be paper based, electronic or a mix of both. It can also take a number of forms, including the referrer’s information, care plan, referrals, checklists, test results, notes and discharge or transition of care summaries. For this action, services are required to have in place systems to ensure that essential information about a person’s care is documented in the healthcare record. For documentation to support the delivery of safe, high-quality care, it should:

• Define when documentation is required
• Be clear, legible, concise, contemporaneous, progressive and accurate
• Include information about assessments, action taken, outcomes, reassessment processes (if applicable), risks, complications and changes
• Meet all necessary medico-legal requirements for documentation, such as record retention timeframes, date and time, or author’s name and designation
• Ensure healthcare providers know how to gain access to the healthcare record, and the healthcare service’s templates, checklists or other tools and resources that support safe, high-quality documentation.

Regardless of the medium (paper or digital), high-quality documentation should follow the same guiding principles as outlined in Table 3.

Table 5: Guiding principles for high-quality documentation

Source: Amended from Documenting information, Communicating for Safety resource portal (ACSQHC, 2022)

Links to Action 3.25 Processes for effective communication.

• Develop and implement processes to correctly match patients with their intended health care using defined patient identifiers
• Ensure your healthcare service has relevant, accurate, complete and up-to-date information about patients’ care documented in their healthcare record
• Ensure that patients’ healthcare records are available and accessible to those involved in their care

• In your healthcare service when do you need to match patients to their health care and what processes are used?
• What documentation does your healthcare service require in the patient’s healthcare record?
• What processes are in place to ensure your patients’ healthcare records are accurate and complete?
• How are healthcare records accessed by all those involved in the patient’s care?

• Documents that describe how patients are matched to their care
• Communication materials or training records that demonstrate the workforce has been educated on the relevant protocol for correctly identifying a patient
• Observation of healthcare records where the information used to identify a patient and match them to their care is documented
• Observation of healthcare records being available to clinicians at the point of care

Australian Commission on Safety and Quality in Health Care: Communicating for Safety resource portal. Provides practical support for the implementation of the communicating for safety actions in the National Safety and Quality Health Service Standards. The principles and strategies outlined in these resources are broadly applicable.

Australian Commission on Safety and Quality in Health Care: NSQHS Standards User Guide for health service organisations providing care for patients with cognitive impairment or at risk of delirium. Provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the National Safety and Quality Health Service (NSQHS) Standards. The principles and strategies outlined in this resource are broadly applicable.

Australian Commission on Safety and Quality in Health Care: Recommendations for terminology, abbreviations and symbols used in medicines documentation.

Sets out principles for safe, clear and consistent terminology for medicines, and safe terms, abbreviations and dose designations for medicines.

Primary Healthcare Network, Tasmania: Shared Transfer of Care – templates and tools. Organised by strategies for implementing shared transfer of care.

Australia’s health system is complex and the delivery of health care involves a large network of services and providers, across multiple settings. This can include healthcare providers in primary and community healthcare settings, specialist services, acute emergency services and hospital-based services, as well as rehabilitation and palliative care.

It is common for a person to access multiple healthcare services and healthcare providers; and to be referred or transferred between different providers and services.

At transitions of care, situations when all or part of a person’s care is transferred between healthcare locations or providers, and as the patient’s conditions and care needs change, the risk of communication errors is increased.

Communication errors and ineffective communication between healthcare providers, multidisciplinary teams and with the patient and their family or carer can lead to poorer health outcomes, patient distress and inappropriate care. Therefore, the healthcare service should support its healthcare providers to refer to and collaborate with other care providers by:

• Using best-practice structured communication processes
• Considering the patient’s risks, goals and preferences for health care when communicating with, and in referrals to, other providers and services
• Communicating information that is current, comprehensive and accurate
• Including the patient, their carer and family in communication processes.

Healthcare providers must be supported to:

• Know the healthcare service’s processes, tools and forms for communicating at transitions of care
• Know who to communicate with and when they need to communicate for any particular transition of care
• Identify what minimum information is required to be communicated for any particular transition
• Have the skills to undertake structured communication
• Have the skills to communicate effectively with patients, families and carers, including agreeing what information they consent to be shared with other healthcare providers.

• Identify resources and tools to encourage effective communication processes and tailor resources to suit your healthcare service
• Ensure your workforce is trained in the use of your healthcare service’s processes and resources to support effective communication

• What resources or processes does your healthcare service have to support communication and collaboration with other care providers when a patient is being referred?
• How is your workforce supported to develop and maintain skills for effective communication?

• Documents outlining the process for communicating emerging or changing critical information
• Templates to support clinical communication, such as referral forms, standardised comprehensive care plans, medication lists or checklists for referrals
• Templates or tools that support healthcare providers to partner with the patient to communicate critical information, risks and goals or preferences
• Examples of referrals or communication between healthcare providers and the patient

Australian Commission on Safety and Quality in Health Care: Communicating for safety resource portal. Provides practical support for the implementation of the communicating for safety actions in the National Safety and Quality Health Service Standards. The principles and strategies outlined in these resources are broadly applicable.

Effective communication with a patient about their appointment/s can maximise their attendance and supports more informed self-management.

Once planned, communication processes to maximise patient attendance at appointments include:

• Ensuring the appointment details have been communicated with the patient in a manner that meets their needs and preferences (for example, using preferred name, language) and at an agreed time and date
• Including support workers, carers or a nominated contact in communications about planned appointments, if agreed with the patient
• Liaising with other healthcare providers involved in the patient’s care such as a general practitioner or care coordinator to identify opportunities for patients to attend
• Considering opportunities to extend or varying operating hours
• Adopting a flexible rescheduling and cancellation policy
• Ensuring the healthcare service provides a safe and welcoming environment for the patient population
• Providing a reminder service for patients either by phone, SMS, or email.

To enable effective communications, patient contact details must be recorded at the time of appointment booking. Healthcare services should ensure that the patient’s contact details remain up to date at each episode of care to facilitate future follow-up care and treatment.

For walk-in appointments, these communication strategies can be engaged for follow-up appointments where relevant.

• Develop and implement communication processes to maximise patient attendance at planned appointments

• How does your healthcare service communicate planned appointments to patients?

• Process for booking appointments
• Communication processes used prior to an appointment
• Examples of appointment reminders such as phone records in patient healthcare records, text messages, or email reminders.

Resources relating to this Action may be added as they become available. 

Through the course of delivering health care, healthcare providers may learn critical information that may be relevant to other healthcare providers involved in a patient’s care. Sharing this information can lead to the best possible outcomes for patients and support multidisciplinary collaboration. Healthcare providers can use existing communication processes to convey critical information, alerts and risks in a timely way, when they emerge and change, to:

• Relevant healthcare providers involved in the patient’s care
• Patients, carers and families, in accordance with the patient’s preferences.

Identifying critical information

The nature of critical information or a risk to patient care identified depends on factors such as the type of service delivered and patient risks. Types of critical information could include:

• Changes to medicines or treatment
• Missed referrals or results
• Wrong diagnosis or results
• Change in patient goals, preferences or condition
• Allergies or adverse drug reactions
• Issues with equipment or medical supplies
• Information that requires follow-up with another healthcare provider (for example, the general practitioner) or the patient (or carer or family, where appropriate).

Communicating critical information

Healthcare services should have established processes to communicate critical information, alerts and risks to:

• Relevant healthcare providers within the same healthcare service
• Relevant healthcare providers within a different healthcare service
• Patients, carers and families.

The communication method adopted will depend on the information provided and the level of urgency involved. Examples include telephone call, referral, SMS or a combination of all.

• Define ‘critical information’ and ‘risks to patient’s care’ for your service
• Use standardised processes to communicate critical information, alerts or risks to relevant healthcare providers and patients, carers and families in a timely way

• How do you communicate critical information, alerts and risks to other healthcare providers within your healthcare service?
• How do you communicate critical information, alerts and risks to healthcare providers in other healthcare services?  
• How do you determine a patient’s preferences for sharing their health information within your service, with other services and to their carers and families?

• A document describing the types of critical information likely to be received and actions taken in response
• Process for communicating critical information (for example, by telephone or secure electronic means) to the relevant healthcare providers including
  • method for communicating critical information to the patient, carer and family
  • time frames for communicating critical information
  • expectations for the healthcare provider and requirements for the patient’s care
• Standardised templates to support communication of critical information, such as referrals, templates or progress notes that are updated in line with identified risks, patient feedback and recommendations
• Observation of critical information being discussed, shared with the appropriate healthcare provider or the patient, and acted upon

Australian Commission on Safety and Quality in Health Care: Communicating for safety resource portal. Provides practical support for the implementation of the communicating for safety actions in the National Safety and Quality Health Service Standards. The principles and strategies outlined in these resources are broadly applicable.

Australian Commission on Safety and Quality in Health Care: NSQHS Standards User Guide for health services providing care for people with mental health issues. Provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the National Safety and Quality Health Service (NSQHS) Standards. The principles and strategies outlined in this resource are broadly applicable.

New critical information that affects a patient’s health care comes from various sources, including patients, carers and families.

For the right care to be delivered and action to occur, critical information must be timely. Healthcare services must ensure that patient, carers and families know how best to communicate critical information to the healthcare provider. These processes must be straightforward and easy to follow.

The healthcare service should establish a process for patients, carers and families to communicate critical information:

• Before or at the initial appointment with the healthcare service
• At different points of care
• After the episode of care at the healthcare service.

This includes patients’, carers’ and families’ information on:

• What could be considered critical information
• Their role in communicating this information
• Resources or communication tools to support communication of critical information to their healthcare providers
• With whom they can communicate critical information.

Information such as key persons and their contact details, or an after-hours emergency contact number can be communicated to patients, carers and families in different forms. These include:

• Displays in common areas of the healthcare service
• Providing a phone number for patients, carers and families to call if they are concerned, particularly if it is after the episode or care at the healthcare service
• Providing written or verbal information during consultation or treatment.

• Develop and implement processes that describe when and how critical information and risks about a patient’s health need to be communicated to healthcare providers
• Support patients and carers to understand and use these processes

• What do you do to support patients, carers and families to communicate critical information to healthcare providers?
• What feedback processes are in place to let patients, carers and families know that they have been heard and any action that has been taken?

• Information provided to patients, carers and families about processes for communicating concerns to the healthcare providers
• Resources and information for patients, carers or families to use to communicate with healthcare providers, such as phone numbers or where to go for emergency assistance
• Patient notes that identify critical information provided by the patient or family and how this information was acted upon
• Results of a patient experience survey or patient, carer and family feedback about their communication with clinicians and, where necessary, how these results have informed improvement
• Information available online detailing the healthcare service’s communication processes or emergency contact processes (for example, on the healthcare service’s website or social media platform)

Australian Commission on Safety and Quality in Health Care: Communicating for safety resource portal. Provides practical support for the implementation of the communicating for safety actions in the National Safety and Quality Health Service Standards. The principles and strategies outlined in these resources are broadly applicable.

Australian Commission on Safety and Quality in Health Care: NSQHS Standards User Guide for health service organisations providing care for patients with cognitive impairment or at risk of delirium. Provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the National Safety and Quality Health Service (NSQHS) Standards. The principles and strategies outlined in this resource are broadly applicable.

Australian Commission on Safety and Quality in Health Care: NSQHS Standards User Guide for health services providing care for people with mental health issues. Provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the National Safety and Quality Health Service (NSQHS) Standards. The principles and strategies outlined in this resource are broadly applicable.