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American Journal of Critical Care. 2009;18: 21-30 doi:10.4037/ajcc2009353
Copyright © 2009 by the American Association of Critical-Care Nurses.
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Intensive Care Units, Communication Between Nurses and Physicians, and Patients’ Outcomes

By Milisa Manojlovich, RN, PhD, CCRN, Cathy L. Antonakos, PhD and David L. Ronis, PhD. Milisa Manojlovich is an assistant professor and Cathy L. Antonakos is a statistical consultant at the University of Michigan School of Nursing, Ann Arbor. David L. Ronis is an associate research scientist and director of the statistical consulting team at the University of Michigan School of Nursing and is a statistical consultant within the US Department of Veterans Affairs.

Corresponding author: Dr Milisa Manojlovich, University of Michigan School of Nursing, 400 N Ingalls, Room 4306, Ann Arbor, MI 48109-0482 (e-mail: mmanojlo{at}umich.edu).

Background Various factors in hospitals can adversely affect patients’ outcomes, including faulty communication between nurses and physicians. Whether specific communication elements (timeliness, accuracy, openness, understanding) can influence adverse outcomes is unknown.

Objectives To determine the relationships between patients’ outcomes and (1) nurses’ perceptions of elements of communication between nurses and physicians and (2) characteristics of the practice environment.

Methods A cross-sectional survey design was used. Information on ventilator-associated pneumonia, bloodstream infection associated with a central catheter, and pressure ulcers was collected from 25 intensive care units in southeastern Michigan. Simultaneously, 462 nurses in those units (response rate, 53.3%) were anonymously surveyed. The Conditions for Work Effectiveness Questionnaire-II and the Practice Environment Scale of the Nursing Work Index were used to measure characteristics of the practice environment. The Intensive Care Unit Nurse-Physician Questionnaire was used to measure communication between nurses and physicians. Statistical tests included correlation and multiple regression. Analyses were conducted at the unit level.

Results Unit response rates varied from 6% to 100%. Together, variability in understanding communication and capacity utilization were predictive of 27% of the variance in ventilator-associated pneumonia. Timeliness of communication was inversely related to pressure ulcers (r= –0.38; P=.06), and workplace empowerment and scores on the Acute Physiology and Chronic Health Evaluation III were positive predictors of ventilator-associated pneumonia (R2=0.36; P=.005).

Conclusions Not all elements of communication were related to the selected adverse outcomes. The connection between characteristics of the practice environment at the unit level and adverse outcomes remains elusive.






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Copyright © 2009 by the American Association of Critical-Care Nurses.