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Abstract:

Purpose: Barriers to effective patient–provider communication increase the risk that a patient will experience a hospital acquired condition (HAC) that will negatively impact the patient’s health outcomes. Providing patients with communication tools can significantly reduce the risks of experiencing HACs. This article describes how barriers to effective patient–provider communication can impact patient outcomes and reports on the incidence of HACs in patients who received assistive technology to address barriers to patient–provider communication. This topic is of critical relevance, as the COVID-19 pandemic has dramatically increased the number of patients who face communication barriers and the accompanying challenges encountered by their health care providers.

Method/Approach: The researchers compared the number of expected HACs based on previously obtained data to the number of HACs reported among patients who received an assistive technology intervention. Additionally, the impact of COVID-19 on patient–provider communication was discussed through the provision of case descriptions from frontline speech-language pathologists who have worked in COVID-19 intensive care units. Results: The patients who received the assistive technology intervention had a significantly lower incidence of HACs than what would be expected in hospital settings. Clinicians working directly with patients with COVID-19 identified suggestions on how both patients and providers can address the barriers to effective patient–provider communication.

Conclusion: A key to better patient outcomes and lower health care costs will require making the provision of communication tools part of the standard of care for all patients facing barriers to communication.

Abstract:

Purpose: Establishing services for hospitalized patients with complex communication needs (CCNs) requires identifying and addressing both patient-based and institutional barriers. Although the previous paper (Marshall & Hurtig, 2019) focused on patient-based barriers, this paper addresses overcoming institutional barriers. Method: We present a series of cases to illustrate the institutional challenges in meeting the CCNs of patients in an acute care setting.

Results: Each case illustrates how the deployment of augmentative and alternative communication tools required addressing institutional/systems barriers and how critical collaborations help patients with CCNs to more effectively communicate with caregivers and participate in their care.

Conclusion: Building a culture of improved patient–provider communication involves establishing a wider range of interprofessional collaborations and shared resources in order to effectively provide patients with CCNs the tools to summon assistance and communicate with their caregivers.

Abstract:

Purpose: Many hospitalized patients experience barriers to effective patient–provider communication that can negatively impact their care. These barriers include difficulty physically accessing the nurse call system, communicating about pain and other needs, or both. For many patients, these barriers are a result of their admitting condition and not of an underlying chronic disability. Speech-language pathologists have begun to address patients’ short-term communication needs with an array of augmentative and alternative communication (AAC) strategies.

Method: This study used a between-groups experimental design to evaluate the impact of providing patients with AAC systems so that they could summon help and communicate with their nurses. The study examined patients’ and nurses’ perceptions of the patients’ ability to summon help and effectively communicate with caregivers. Results: Patients who could summon their nurses and effectively communicate—with or without AAC—had significantly more favorable perceptions than those who could not. Conclusions: This study suggests that AAC can be successfully used in acute care settings to help patients overcome access and communication barriers. Working with other members of the health care team is essential to building a “culture of communication” in acute care settings.

Supplemental Material: https://doi.org/10.23641/asha. 9990962

Abstract: This forum provides some insights into the process of initiating a clinical service to enhance patient–provider communication. It also provides a report of a large-scale clinical trial that introduced augmentative and alternative communication (AAC) tools in an acute-care setting.

Abstract: Preventable adverse events (AEs) lead to poorer patient outcomes, added patient suffering and dissatisfaction, longer hospital stays, and billions in additional annual health care spending. Patients facing barriers to communication are 3 times more likely to experience a preventable AE than patients who faced no communication barriers. National data on hospital admissions, incidence and cost of preventable AEs, and the odds ratio regarding the risk of preventable AEs in people facing communication barriers were used to estimate potential benefits of improving patient communication. Reducing communication barriers could lead to an estimated reduction of 671,440 preventable AE cases and a cost savings of $6.8 billion annually. Facilitating patient–provider communication is an ethical and financial imperative. A multipronged approach, including increased awareness of and support for speech-language pathology services, is essential to creating a communication friendly hospital culture, reducing patient suffering, and decreasing the financial cost of preventable AEs. Speech-language pathologists and allied health care professionals play a critical role in facilitating patient–provider communication and improving patient outcomes.

https://pubs.asha.org/doi/10.1044/persp3.SIG12.99

Abstract: Children with Rett Syndrome (RS) are reported to use multiple modalities to communicate although their intentionality is often questioned (Bartolotta, Zipp, Simpkins, & Glazewski, 2011; Hetzroni & Rubin, 2006; Sigafoos et al., 2000; Sigafoos, Woodyatt, Tuckeer, Roberts-Pennell, & Pittendreigh, 2000). This paper will present results of a study analyzing the unconventional vocalizations of a child with RS. The primary research question addresses the ability of familiar and unfamiliar listeners to interpret unconventional vocalizations as “yes” or “no” responses. This paper will also address the acoustic analysis and perceptual judgments of these vocalizations. Pre-recorded isolated vocalizations of “yes” and “no” were presented to 5 listeners (mother, father, 1 unfamiliar, and 2 familiar clinicians) and the listeners were asked to rate the vocalizations as either “yes” or “no.” The ratings were compared to the original identification made by the child’s mother during the face-to-face interaction from which the samples were drawn. Findings of this study suggest, in this case, the child’s vocalizations were intentional and could be interpreted by familiar and unfamiliar listeners as either “yes” or “no” without contextual or visual cues. The results suggest that communication partners should be trained to attend to eye-gaze and vocalizations to ensure the child’s intended choice is accurately understood.

Abstract: The number of patients in U.S. hospitals with limited English proficiency (LEP) is growing. There is a body of evidence that suggests that inadequate patient-provider communication is responsible for a range of adverse events, including death. In recognition of this, the Joint Commission has set standards requiring hospitals to address the communication needs of the diverse hospitalized population. Although the optimal approach for LEP patients would involve having certified interpreters at the bedside around the clock, this is unfortunately not practically or economically feasible. Speech-generating devices (SGDs) can offer patients a means of communicating with their caregivers and an opportunity to participate more actively in their care. The University of Iowa Assistive Devices Lab has developed a series of bilingual communication templates suited for use in acute and critical care settings. They developed these templates for use by LEP patients who are speakers of diverse languages, as well as by Deaf patients who use a sign language as their primary means of communication.

Abstract: In 2012, the Joint Commission issued a mandate that accredited hospitals must take into consideration the needs of patients with complex communication needs. Stemming from this mandate came recommendations for hospitals to collect baseline data of the number of individuals in their care with complex communication needs. This is a demographic study in response to their recommendation. Researchers at the University of Iowa sampled the electronic medical records of patients across 7 days to determine the number of patients who met candidacy requirements for augmentative alternative communication or assistive technology. Our census data indicate there is a significant need for patients in acute care settings to have access to alternative communication and the nurse call systems. The need appears to be greater in the intensive care units,but is not limited to this patient population. Overall, patients had greater AT needs than AAC needs in all locations. We recommend future research to investigate service delivery models to improve communication barriers that may exist between hospital staff and patients.

Summary: Raising the possibility of adapting AAC strategies used with individuals facing long term communication barriers to patients in ICUs facing barriers to communicating with healthcare providers.