Exploring current physicians’ failure to communicate clinical feedback back to transferring physicians after transitions of patient care responsibility: A mixed methods study

Abstract

Introduction: After patient care transitions occur, communication from the current physician back to the transferring physician may be an important source of clinical feedback for learning from outcomes of previous reasoning processes. Factors associated with this communication are not well understood. This study clarifies how often, and for what reasons, current physicians do or do not communicate back to transferring physicians about transitioned patients. Methods: In 2018, 38 physicians at two academic teaching hospitals were interviewed about communication decisions regarding 618 transitioned patients. Researchers recorded quantitative and qualitative data in field notes, then coded communication rationales using directed content analysis. Descriptive statistics and mixed effects logistic regression analyses identified communication patterns and examined associations with communication for three conditions: When current physicians 1) changed transferring physicians’ clinical decisions, 2) perceived transferring physicians’ clinical uncertainty, and 3) perceived transferring physicians’ request for communication. Results: Communication occurred regarding 17% of transitioned patients. Transferring physicians initiated communication in 55% of these cases. Communication did not occur when current physicians 1) changed transferring physicians’ clinical decisions (119 patients), 2) perceived transferring physicians’ uncertainty (97 patients), and 3) perceived transferring physicians’ request for communication (12 patients). Rationales for no communication included case contextual, structural, interpersonal, and cultural factors. Perceived uncertainty and request for communication were positively associated with communication (p < 0.001) while a changed clinical decision was not. Discussion: Current physicians communicate infrequently with transferring physicians after assuming patient care responsibilities. Structural and interpersonal barriers to communication may be amenable to change. Clarity about transferring physicians’ uncertainty and desire for communication back may improve clinical feedback communication.