Lesley Gotlib Conn

Studies in General Internal Medicine [GIM] settings have shown that optimizing interprofessional communication is important, yet complex and challenging. While the physician is integral to interprofessional work in GIM there are often communication barriers in place that impact perceptions and experiences with the quality and quantity of their communication with other team members. This study aims to understand how team members’ perceptions and experiences with the communication styles and strategies of either hospitalist or consultant physicians in their units influence the quality and effectiveness of interprofessional relations and work.

The enhanced recovery after surgery (ERAS) programme is a multimodal evidence-based approach to surgical care which begins in the preoperative setting and extends through to patient discharge in the postoperative period. The primary components of ERAS include the introduction of preoperative patient education; reduction in perioperative use of nasogastric tubes and drains; the use of multimodal analgesia; goal-directed fluid management; early removal of Foley catheter; early mobilization, and early oral nutrition. The ERAS approach has gradually evolved to become the standard of care in colorectal surgery and is presently being used in other specialty areas such as vascular surgery. Currently there is little evidence available for the implementation of ERAS in this field. We plan to conduct a systematic review of this literature with a view to incorporating ERAS principles into the management of major elective vascular surgery procedures.

Few methods are available for analysing psychometric properties of combined qualitative and quantitative data. While conventional reliability of measures - meaning reproducibility or consistency - may not be meaningful in small-N research, in some health services studies agreement on perceptions arising from data generated by fieldwork and quantitative measures can be examined to good effect. We studied interprofessional collaboration (IPC) in seven hospitals. An ethnographer shadowed and conducted interviews with regulated health professionals in medicine wards. Concurrently, nurses completed the nurse-doctor relations subscale of the Nursing Work Index (NWI-NDRS) and a new measurement scale for IPC with doctors in the domains of communication, accommodation, and isolation. After fieldwork, the ethnographer rank-ordered hospital sites on IPC from 1 to 7 based on interpretation of the qualitative data. Mean-scale scores were calculated for hospital sites and converted to ranks similarly. The Tinsley-Weiss T-index (Tinsley & Weiss, 1975) for agreement among rank orderings was calculated for dyadic combinations of fieldwork and measurement ranks. Perfect agreement was obtained for the most liberal agreement definitions considered - differences of two rank positions - involving qualitative data agreement with IPC subscales for accommodation and isolation. Defining agreement as a difference of 1 rank at most, the T-index was 0.77 for agreement between fieldworker and IPC accommodation and the same for NWI-NDRS and IPC isolation. Qualitative data from fieldwork rankings were substantially in accord with the contemporary IPC scales, less so with the NWI-NDRS. Qualitative data appear to be useful as an additional approach to confirming the validity of quantitative scale data in measuring a complex interpersonal relational construct.

An abundance of evidence suggests that communication in interprofessional healthcare teams is a complex endeavour. Even relatively simple communication processes involving information work – the gathering, storage, retrieval and discussion of patient information – may be fraught with pitfalls, and yet teams manage to conduct their daily information work, often with a high degree of effectiveness. In this article, we explore one commonplace dimension of information work – the use of patient charts to foster collaborative decision-making and care enactment – towards building an elaborated understanding of how teams innovate in the face of daily complexities in their information work processes. Drawing on results from an ethnographic study of team communication in two internal medicine inpatient wards, we describe the nature and use of patient charts, analyze recurrent problems, and explore adaptive strategies for carrying on team information work in the face of daily barriers.