Barriers to communicating well between teams and systems: what we heard from clinicians
We spoke to clinicians to better understand the challenges they see when communicating with different teams or across settings.
Poor information flow across settings
Clinicians told us that the movement between settings is where information most often breaks down, as it becomes more difficult to find and access:
‘For patients remaining in the hospital setting, in a way that’s easy because they’re within a single system. When you go into any setting that's not the hospital, it’s incredibly problematic to get the communication to the right individuals in a timely way… It is almost impossible to find the right phone numbers, to get the right person to answer the phone or to get the right email address.’
Clinicians agreed that patients’ wishes should be easy to access and shared consistently across services. But we heard that electronic patient records are still not reliably shared across organisations and are used inconsistently, leaving teams without critical background information at important moments:
‘What I haven’t seen enough of is, the advance care planning that some patients have made in the community has not filtered enough through to the hospital.’
Electronic Palliative Care Coordination Systems (EPaCCS) were introduced in England from 2008 onwards to support care coordination and delivery in line with patient preferences. But research into the use of EPaCCS suggests there is considerable variation in how they have been implemented across England. Where EPaCCS are present, only a limited proportion of those who may be eligible for an EPaCCS record are receiving one before death, with limited recording of preferences for care. Ongoing interoperability challenges mean there is not consistent sharing across settings such as care homes and ambulance trusts. Clinicians also told us they perceive EPaCCS as a tool more commonly used in primary care and less frequently in hospital settings.
Quality of record-keeping
Clinicians told us that pressure on time and staffing capacity limits good record-keeping. There is not always a standardised way to record ‘what’s been tried’, what has mattered to the patient or what small adjustments improved comfort.
We heard about the importance of training healthcare professionals on documenting information effectively. One clinician told us:
‘[In the context of more multidisciplinary team working] it’s really important to make sure documentation is clear of who you’ve spoken to, what time, what was said, where are you directing the next conversation to, to who. Someone’s about to lose a loved one and not documenting, not getting the right information for the next person to follow through can cause an issue. I think training around platforms and clear directives about which sections and where things need to be documented has to be coordinated very tightly.’