OASIS Alert

Establish a rapport with office staff to hasten communication improvement.

Better communication with physicians means better and safer care for your patients. Try the SBAR approach and see how quickly you'll be able to get your point across.

For a home health nurse, getting a direct line to speak with a physician is a challenge. One way to help is to educate new nurses about this challenge and develop a strategy to address it before they start the work, says Boston-based Debra Bertrand, BSN, RN with Beth Israel Deaconess Medical Center.

Look at the big picture for establishing effective communication before you need to make that call, says Bertrand, who spent a number of years in the field as a home health clinician.

Consider the timing of your approach and the vehicle you use to communicate, Bertrand says. Check with the frontline manager of the physician's office. Ask what communication format the doctor prefers -- does he like e-mail, a phone call during office hours, or a fax along with a "heads-up" call to staff? And what should you do if you have a timely issue?

The frontline manager can tell you when to call and how to get the doctor to call back. Using a cell phone and giving the doctor the option to call back can be a huge help.

Bottom line: Find out the doctor's preferences before you even enter into communication.

A Situation-Background-Assessment-Recommendation (SBAR) tool can be powerful in streamlining communication. This tool helps you to summarize the patient's situation, background, assessment, and recommendation so you have all the details at hand when you contact the physician. See the sample SBAR worksheet created by Quality Insights of Pennsylvania on page 82.

Bonus: Having all of your points ready and practicing before you make the call can give you more confidence, Bertrand says.

Problem: Physicians can be busy and have similar stresses to the ones you experience as a nurse. They may have a tendency to view your call as an interruption, Bertrand says. Being able to communicate quickly and effectively shows the doctor that you value his time and can ease the stress all around.

The SBAR model forces you to think through the issue and to make specific recommendations, says Pat Jump with Rice Lake, Wis.-based Acorn's End Training & Consulting. "Sometimes clinicians are reluctant to make recommendations to the physician thinking this is akin to diagnosing." But most physicians appreciate it when the clinician makes a recommendation, because they recognize that the clinician often times knows the patient better than the physician does, she says.

Try this: If you are in the general area, drop in and say hello. Putting a face with your voice really helps, Bertrand says. You'll often find the "firewall" in the front of the office, and bringing her a cup of coffee and saying "Thanks for helping me out with Mrs. Jones" isn't bribery -- it's a show of mutual respect, she says.

Tip: Many clinicians report success with faxing their communication to doctors. That could be as easy as sending along your completed SBAR form. But you still need to establish a rapport with the folks in the office to make sure the fax gets to the doctor.

Editor's note: For a detailed packet on using the SBAR in home health, see the Collaboration for Homecare Advances in Management and Practice (CHAMP) website at www.champ-program.org/static/Entire_SBAR_Package.pdf.