Evidence Table

SourceCommunication TargetsDesign TypeStudy Design, Study Outcome Measure(s)Study Setting & Study PopulationStudy InterventionKey Finding(s)
Randomized Controlled Trials
Ellison 2004159PatientsDesign Type 2 (RCT) (Level 2) questionnairePatient satisfaction (Level 3)1 hospital 85 patientsStandard care plus1 day telerounding; standard care substituting 1 day with robotic teleroundingImprovement in telerounding patients of examination thoroughness, quality of discussion, postoperative care coordination, availability of MD; in robotic telerounding improvement in availability of MD.
Fallowfield 2003153MD/patientDesign Type2 (RCT)— pre/postvideotape (Level 2)At 12 months, same as 3 months (Level 3)Oncology MDs, UK3 day residential communication skills training courseSame effect with use of leading questions, open-ended questions, and response to patient cues; improvement in fewer interruptions, increased summarizing; decline in expressions of empathy.
Jenkins 2002152MD/ptDesign Type 2 (RCT)—P-P videotape (Level 2)At 3 months attitudes, empathy, responses (Level 3)Oncology MDs, UK3 day residential communication skills training courseImproved attitudes and beliefs toward psychosocial issues compared to controls; increased expressions of empathy; open questions; appropriate responses to patient cues and psychosocial probing; self-reported changes in communication styles.
Joos 1996157MD/ptDesign Type 2 (RCT)—P-P questionnaire (Level 2)Communication skills (Level 3), and compliance and utilization (Level 2)42 MDs and 348 patients with chronic conditions4.5 hours of trainingIncreased number of times MDs elicited patient and RN concerns, increased patient perception of amount of information received, no change in patient compliance with medications or appointments; no change in patient utilization.
Levinson 1993156MD/ptDesign Type2 (RCT)—P-P audiotape (Level 2)Communication skills (Level 3)53 community-based MDs and 473 patientsA short CME program (4.5 hours) and a long CME program (2.5 days)Short program: no effect. Long program: more open-ended questions, asked patient opinions, gave more biomedical information, patients disclosed more information, decrease in negative affect for both, patients had fewer signs of outward distress during visit.
Lozano 2004154MD/children (3–17) with asthmaDesign Type2 (RCT)—cluster P- P interview and questionnaire (Level 2)Asthma symptom days, asthma-specific functional status, frequency of oral steroid courses (Level 1)42 primary care practices in 3 locationsPeer leader education (PLE) and peer leader + nurse-mediated organizational change (PACI)Peer leader: fewer symptom days per year & lower oral steroid rates. Peer leader + nurse: fewer symptom days per year & greater adherence to treatment by parent report.
Sullivan 2005155MD/children (3–17) with asthmaDesign Type 2 (RCT)—cluster P- P interview and questionnaire (Level 2)Symptom-free days (SFDs); asthma-related health care costs (Level 1)42 primary care practices in 3 locationsPeer leader education (PLE) and peer leader + nurse-mediated organizational change (PACI)SFD: 6.5 with PLE vs. usual, 13.5 with PACI vs. usual; compared with usual incremental cost effectiveness ratio was $18/SFD gained for PLE and $68/SFD gained for PACI.
Tran 2002158ED patientsDesign Type 2 (RCT) (Level 2) questionnairePatient length of stay (LOS), wait time, perception of LOS, ratings of nurse skills and MD skills (Levels 3 & 4)1 hospital ED 619 patientsProviding patients with information q 15 minutes during stayNo difference in LOS, wait time, nurse skills. Decrease in perceived LOS and wait time and increase in perception of MD skills.
Nonrandomized Controlled Trials and Quality Improvement (QI) Projects
Boyle 20044MDs/RNsDesign Type 6 P-P 2 units no control (Level 5)Communication skills, increased staff satisfaction, lower stress, increased problem-solving using videotape vignettes, questionnaire1 ICU from 2 hospitalsCollaborative Communication Intervention over 8 months: 23.5 hours for 6 modulesIncreased perceived RN and MD communication skills, improved nurse leadership and problem-solving, decreased staff nurse personal stress.
Copnell 2004134MDs/RNsDesign Type 6 P-P 2 units no control (Level 5)Perception of collaboration2 NICUsAdded NPNo difference before and after NP; MDs and RNs disagreed about collaboration with MDs scoring higher.
Dechairo-Marino 2001166RNsDesign Type 6 action research— P-P 1 group-no control (Level 5)RN reports of collaboration with MDs and RN Satisfaction with decisionmaking process- (Level 3)1 university teaching hospital; RNs in 3 med-surg units and 2 ICUsActivities to promote interdisciplinary teamwork between MDs/RNs, including developing principles, discussion in meetings, 1 4- hour class on decisionmakingNo differences
Dutton 2002170MDs, nurses, patients discharge plannersDesign Type 8-no control group (Level 5)Patient volume, LOS, ED closure (Level 3, 4)1 hospital trauma serviceDaily discharge multidisciplinary roundsIncrease in patient volume, decrease in LOS, decrease in ED closure.
Lassen 1997169Well-newborn nurses, pediatricians, neonatologistsDesign Type 13- QI project with a control time (Level 5)# of admissions with R/O sepsis, LOS, # of doses of antibiotics, costs, # of readmissions, reduction in practice variation (Levels 1, 2, 3)1 tertiary hospitalCollaborative practice decisionmaking protocol development; educationDecrease in # of R/O sepsis diagnosis, decease in % of patients treated with antibiotics, decrease in patient days, decrease in costs, decrease in readmissions.
Leonard 2004168Various groups in Kaiser PermanenteDesign Type 14- QI project-no control (Level 5)Improve communication and teamwork by standardized communication (Level 3)different groups of MDs and RNsIntroduce standardized communication methods such as SBAR, assertion, checklists, critical event training, and briefingsStandardized briefings related to reduced wrong-site surgery, decreased nurse turnover, improved employee satisfaction, improved teamwork climate, communication, and taking responsibility for errors—but few specifics provided.
McFerran 2005167Perinatal RNs, certified registered nurse anesthesists and MDsDesign Type 13 QI project-no control (Level 5)Long-term measures: birth event data, medical-legal data, patient satisfaction data (Levels 1 & 2); short-term measures: implementation of 2–3 interventions using human factors technique during 1 year (Level 3)4 Kaiser Permanente medical centers perinatal staff4-hour human factors education program, SBAR communication technique, revising escalation policy, identifying safe communications, debriefs after adverse events, multidisciplinary reports, assertion, just culture statement (Level 3)No long-term measures reported; 4 sites met short-term expectations for only communication initiatives.
Roberts 1976163Hospital employees (non-MD and nonsupervisors)Design Type 3— NRCT-P-P 2 groups with 1 being control (Level 3)Employee perception of organizational communication, job satisfaction, and opportunities for innovative job behavior (Level 3)1 urban hospital; ED staff members2.5–3 hour training sessions weekly for 4 consecutive weeksIncrease satisfaction with work, pay, coworkers, job; increase perception of opportunities for innovation; increase desire for interaction with peers; and decrease in information overload.
Weiss 1985165MD/RN/consumerDesign Type 3— NRCT with 3 groups, with 2 being matched control groups (Level 3)Belief regarding value of shared versus physician-dominated responsibility for health care and beliefs that powerful individuals influence consumer health status (Level 4)Recruited in large urban areaDiscussion of role relationships, and problems for 2.5 hours 1 evening/month for 20 monthsDecline in belief in shared versus physician-dominated responsibility for health care and increase in belief that powerful individuals influence the consumer’s health status.
Vazirani 2005164Unit organization; RN, MD, residents, hospitalist, NPDesign Type 3— NCRT 2 groups with 1 being control (Level 3)Collaboration, communication (Level 3)1 hospital; 1 control unit and 1 intervention unitAdded NP, hospitalist, daily multidisciplinary roundsPerception by MDs of greater collaboration between physicians and nurses with largest effect with residents, between physicians and NPs, better communication between MDs; no difference in nurse perception of communication or collaboration between nurses and MDs, nurses perceived better communication with NPs than MDs.
Systematic Literature Reviews
Di Blasi 1996 (Cochrane Collaboration-Centre for Reviews and Dissemination)161Patients with various health problemsDesign Type 11 structured review (Level 1) RCTs with and without placeboHealth outcome, symptom resolution, functional status (Level 1); health service use, medication adherence, anxiety, satisfaction (Level 3)26 studies with 3,811 participants: poor quality studies with small sample sizesVarious treatments or disease management, including labeling, changing patient expectations, combining treatment information with emotional supportLabeling: no effect; changing patient expectations: conflicting results—improved lung function with suggestion of drug effects but improved systolic blood pressure following any interaction; combined information with support: improved outcomes, mixed result—6 studies found decrease in pain with improved patient-practitioner interaction, style of interaction can influence physical health but with small effects.
Hulsman 1999 (Cochrane Collaboration-Centre for Reviews and Dissemination)160Graduate or postgraduate MDsDesign Type 11 structured review (Level 1); evaluation studies RCT and NRCT P-P video, discussion, role play, audio, written, self-ratingReceptive behaviors, information behavior, interpersonal and affective behavior, psychosocial problems and emotions (Level 3); compliance, health status, psychosocial status (Level 2)14 studies, 408 participants, 135 controlsTraining, education using lecture, modeling, discussion, role play—4–96 hours over 2 days to 6 months10 studies report some training effect with best designed reporting fewest effects; improved self-rating of communication and recognition of psychosocial patient problems, no conclusive patient compliance effect, no effect on health status, ambiguous effect of psychosocial health. The other 4 studies report no effects.
Zwarenstein 2000 (The Cochrane Collaboration)100Chiropodists/podiatrists, dentists, dietitians, MDs, hygienists, psychologists, nurses, pharmacists, occupational therapists, and othersDesign Type 11 structured review (Level 1); RCT, controlled before and after, and interrupted time seriesSelf-reported health status, disease incidence, cure rates, mortality, complication rates (Level 1); adherence, satisfaction, continuity of care, costs (Level 3)89 studies; none met the inclusion criteriaInterprofessional education (IPE) versus single-discipline educationNo conclusive evidence of the effectiveness of IPE in relation to professional practice or health outcomes.
Zwarenstein 2000 (The Cochrane Collaboration)100MDs/RNsDesign Type 11 structured review (Level 1); RCT, controlled before and after, and interrupted time seriesMD/RN collaboration/joint decisionmaking (Level 3), costs(Level 4); LOS, mortality (Level 1)2 studies with 1,102 admissions in one and 417 admissions in the otherTraining, workshops, ward reorganization, team development, meetings, patient-centered care, 4 times weekly rounds, weekly case conference1st study: shorter LOS, reduced costs, no difference in mortality rate, increased staff satisfaction. 2nd study: no difference in LOS and no difference in mortality rates.
Descriptive
Aiken 1994171MDs/RNsDesign Type 4 cross-sectional (Level 5)Medicare mortality rates (Level 1)39 Magnet hospitals, 139 controlsNoneMagnet hospitals (higher autonomy, control, MD relationships, RN hours, skill mix) had lower Medicare mortality rates.
Aiken 199999MDs/RNsDesign Type 4 cross-sectional (Level 5)30-day mortality, patient satisfaction, nurse-patient ratios, control by bedside nurses; specialty physicians (Levels 1, 3)40 units in 20 hospitals; 1,205 patients and 820 nursesNoneBetter nurse-patient ratios, lower mortality; higher nurse control, higher patient satisfaction.
Alt-White 1983105MDs/RNsDesign Type 4, 8 cross-sectional no comparison group (Level 5)Nurse-physician collaboration (Level 3)46 units, 446 nursesNonePrimary nurse, critical care units, unit communication, coordination, nurse satisfaction associated with better collaboration.
Baggs 1997107MDs/RNsDesign Type 4, 8 cross-sectional no comparison group (Level 5)Nurse/physician collaboration and satisfaction with decisionmaking, nurse retention (Level 3)3 ICUs in 3 hospitalNoneCollaboration was associated with satisfaction for all but more strongly for nurses; nurse satisfaction with decisionmaking was not associated with retention.
Baggs 199995MDs/RNsDesign Type 4, 8 cross-sectional no comparison group (Level 5)Mortality, ICU readmission (Level 1)3 ICUs in 3 hospitalsNoneIn the medical ICU, there was an association between nurse perception of collaboration and lower risk of patient death or ICU readmission; MD reports of collaboration were not associated with patient outcomes.
Estabrooks 200598MDs/RNsDesign Type 4, 8 cross-sectional no comparison group (Level 530-day mortality49 hospitalsNoneGreater nurse-physician relationships, more temporary positions, higher nurse education level, and richer skill mix associated with better 30-day mortality.
Kaissi 2003106MDs/RNsDesign Type 4, 8 cross-sectional no comparison group (Level 5)Nurse-physician interpersonal interaction/teamwork (Level 3)2 hospitalsNone78% of nurses rated experience with MDs as very low/low or adequate.
King 1994108MDs/RNsDesign Type 4, 8 cross-sectional no comparison group (Level 5)Nurse-physician collaboration (Level 3)90 nurses, 40 physicians, 4 hospitals, and 2 hospital shipsNoneMDs & RNs disagreed with MDs perceiving higher collaboration than RNs.
Knaus 198697MDs/RNsDesign Type 4, 8 cross-sectional with no comparison group (Level 5)Actual and predicted mortality, coordination of care (Levels 1, 3)13 hospitalsNoneHospitals with less actual mortality than predicted had better coordination of care and communication between RNs/MDs and among MDs.
Rosenstein 200236RNs/MDs/executivesDesign Type 4, 8 cross-sectional with no comparison group (Level 5)Nurse-physician relationship (Level 3)Network of hospitals; 1,200 responses from RNs, MDs, executivesNoneMDs and RNs were significantly different; more RNs have witnessed disruptive MD behavior, more RNs say the disruptive behavior is important in nurse morale; nurses perceive less support for conflict; nurses perceive MDs as unaware of relationship.
Zimmerman 1993103MDs/RNsDesign Type 4, 8 cross-sectional with no comparison group (Level 5)Strong medical and nursing leadership, collaboration, coordination, communication, mortality, LOS (Levels 1, 3)9 ICUs in 9 hospitals; 316 RNs and 202 MDsNoneNo difference in risk-adjusted mortality or LOS between high-performing and low-performing ICUs.
Shortell 1994101MDs/RNsDesign Type 4, 8 cross-sectional no comparison group (Level 5)LOS, nurse turnover, technical quality of care, meeting family needs (Levels 3, 4)42 ICUsNoneHigher scores on leadership, coordination, communication, conflict management, associated with shorter LOS, higher technical quality of care, greater ability to meet family needs.
Thomas 200370MDs/RNsDesign Type 4, 8 cross-sectional no comparison group (Level 5)Collaboration, communication (Level 3)8 ICUs in 2 hospitals; 90 MDs, 230 RNsNoneMost MDs rated collaboration and communication as high or very high; most RNs rated it as low or very low.
Zimmerman 1991102MDs/RNsDesign Type 4, 8 cross-sectional no comparison group (Level 5)ICU LOS, predicted hospital mortality (Levels 1, 3)40 hospitalsNoneLower mortality associated with better technological adequacy and work environment; shorter LOS associated with better communication, culture, coordination, conflict management.

From: Chapter 32, Professional Communication

Cover of Patient Safety and Quality
Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Hughes RG, editor.

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