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Novel use of communication technology to improve nurse-physician
communication, teamwork, and care coordination during bedside rounds*

Alexis Wickersham a, Krista Johnsonb,c, Aparna Kamathc,d and Peter J. Kabolib,c,e

aDepartment of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; bIowa City VA Healthcare
System, Iowa City, IA, USA; cDepartment of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; dDepartment of
Medicine, Duke University School of Medicine, Durham, NC, USA; eComprehensive Access and Delivery Research and Evaluation (CADRE)
Center at the Iowa City VA Healthcare System and VA Quality Scholars Fellowship Program, Iowa City, IA, USA

ABSTRACT
Background: Inter-professional bedside rounding has been used to reduce communication
deficits and improve patient outcomes. Our objective was to evaluate nurse and physician
participation in inter-professional bedside rounds and perceptions of communication,
teamwork, and care coordination, through a quality improvement (QI) intervention.
Method: A web-based survey was completed by attending and resident physicians and nurses
working on the general medical wards of an academic-affiliated Veteran’s Health Administration
Hospital (VHA). Responses were assessed using the chi-square statistic. Qualitative responses
were grouped into themes for analysis to guide the intervention. A pre-existing electronic
communication device was utilized in a novel way by resident physicians to facilitate nursing
participation in bedside rounds. Perceptions of communication, teamwork, and care
coordination between nurses and physicians prior to and after introduction of the electronic
communication device were assessed. Direct observation was used to assess nursing
presence during physician team rounds.
Results: Following the intervention, both nurses and physicians agreed more nurses were
alerted by physicians when rounds began and better communication between nurses and
physicians occurred. However, technological barriers limited sustainability. Nursing presence
on rounds increased from a baseline of 16.5% to 36% post-intervention.
Conclusions: Implementation of a voice-activated, communication device on rounds facilitated
improvement in perceptions of communication, teamwork, and care coordination, which may
ultimately impact cultural change and patient outcomes.

KEYWORDS
Teamwork; inter-professional
communication; care
coordination; technology;
hospital medicine

Introduction

Creating a culture of safety is a cornerstone of the VHA
[1] and prior work demonstrates that communication
deficits are a leading cause of medical errors that can
lead to patient harm [2]. There have been several
studies aimed at improving inter-professional involve-
ment in physician rounds, but despite these efforts,
many barriers to bedside collaboration exist, including
percept

R E V I E W

Nurse–physician communication – An integrated review

Tit-Chai Tan RN, MSc, Nurse Clinician1 | Huaqiong Zhou RN, BSc, MCN, PhD Candidate,

Research Officer, Lecturer2 | Michelle Kelly PhD, MN, BSc, Associate Professor, Director:

Community of Practice2

1Tan Tock Seng Hospital, Singapore,

Singapore

2School of Nursing, Midwifery and

Paramedicine, Curtin University, Perth, WA,

Australia

Correspondence

Tit-Chai Tan, Tan Tock Seng Hospital,

Singapore, Singapore.

Email: [email protected]

Aim and objective: To present a comprehensive review of current evidence on the

factors which impact on nurse–physician communication and interventions devel-

oped to improve nurse–physician communication.

Background: The challenges in nurse–physician communication persist since the term

‘nurse-doctor game’ was first used in 1967, leading to poor patient outcomes such as

treatment delays and potential patient harm. Inconsistent evidence was found on the fac-

tors and interventions which foster or impair effective nurse–physician communication.

Design: An integrative review was conducted following a five-stage process: prob-

lem identification, literature search, data evaluation, data analysis and presentation.

Methods: Five electronic databases were searched from 2005 to April 2016 using

key search terms: “improve*,” “nurse-physician,” “nurse,” “physician” and “communi-

cation” in five electronic databases including the Cumulative Index to Nursing and

Allied Health Literature (CINAHL), MEDLINE, PubMed, Science Direct and Scopus.

Results: A total of 22 studies were included in the review. Four themes emerged

from the data synthesis, namely communication styles; factors that facilitate nurse–

physician communication; barriers to effective nurse–physician communication; and

interventions to improve nurse–physician communication.

Conclusion: This integrative review suggests that nurse–physician communication still

remains ineffective. Current interventions only address information needs of nurses

and physicians in limited situations and specific settings but cannot adequately

address the interprofessional communication skills that are lacking in practice. The dis-

parate views of nurses and physicians on communication due to differing training

backgrounds confound the effectiveness of current interventions or strategies.

Relevance to clinical practice: Cross-training and interprofessional educational from

undergraduate to postgraduate programmes will better align the training of nurses

and

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