Poor communication closely associated with patient safety incidents

1. In this systematic review and meta-analysis, poor communication was found to contribute to nearly a quarter of patient safety incidents.

2. Poor communication amongst clinical staff members and between clinical staff and patients were both implicated in a large fraction of patient safety incidents.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Preventable harm affects 1 in 20 patients and makes up over 50% of overall patient harm worldwide. Poor communication, including miscommunication, communication errors, and lack of adequate communication, is a major cause of preventable harm, leading to misdiagnosis and sometimes life-threatening complications. However, the existing literature on poor communication and patient safety is somewhat narrow in scope and has not been synthesized in many years. This systematic review therefore aimed to assess the extent to which poor communication may lead to patient safety incidents. Overall, poor communication was shown to directly cause between one-tenth and one-quarter of patient safety incidents. Poor communication between clinical staff was shown to directly cause approximately one-fifth of incidents, while poor communication between clinical staff and patients was shown to contribute to up to one-third of incidents. The generalizability of this study is limited by the high degree of heterogeneity, the low quality of studies, poor reporting of patient data, and a lack of descriptions of how poor communication mechanistically resulted in patient safety incidents. Nevertheless, this study showed the impact of poor communication on patient safety, emphasizing the need to improve this element of health care provision.

Click to read this study in AIM

Relevant Reading: A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

In-Depth [systematic review and meta-analysis]: This systematic review aimed to determine the extent to which poor communication may cause or contribute to patient safety incidents. Included studies were conducted from 2013 to 2024 and quantitatively examined patient safety incidents involving health care practitioners and poor communication. A total of 46 studies were included in this review, 13 of which were from Asia, 15 from Europe, 15 from North America, 2 from South America, and 1 from Africa. Low risk of bias was found in 20 studies, moderate risk in 16 studies, and high risk in 10 studies. Poor communication was found in 4 studies to be the only cause of a median of 13.2% of patient safety incidents, while 42 studies showed that poor communication contributed to a median of 24.0% of incidents. In 3 studies, poor communication between clinical staff caused a median of 19.4% of patient safety incidents; in 25 studies that looked at poor communication between clinical staff as a contributing factor, it contributed to a median of 22.4% of incidents. Poor communication between clinical staff and patients was found in 5 studies to be a contributing factor to a median of 34.0% of patient safety incidents. Poor communication overall contributed to a median of 13.3% (IQR, 1.9% to 44.1%) of medication errors, 25.7% (IQR, 13.0% to 45.2%) of near misses, 37.3% (IQR, 2.6% to 52.9%) of medical errors, and 40.5% (IQR, 14.3% to 66.4%) of adverse events. Sensitivity and subgroup analyses showed that poor communication contributed to a median of 22.4% (IQR, 14.7% to 42.5%, n = 19) of patient safety incidents in studies with a low risk of bias, 24.2% (IQR, 5.8% to 50.8%; n = 14) in studies with moderate risk of bias, and 47.9% (IQR, 11.8% to 53.9%; n = 9) in studies with high risk of bias. Overall, this study showed the impact of poor communication on various types of patient safety incidents.

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