Introduction

Effective communication underpins clinical governance and ensures professionalism throughout the NHS^1,2. In this context, the importance of communication between healthcare professionals regarding patient care is increasingly important, especially for record keeping and demonstrating professional accountability and responsibility, prerequisites for clinical governance. Previous work by has shown that a lack of communication across the health care interface leads to problems between the supplies of prescribed medicines; improved communication at discharge can reduce clinically significant discrepancies^3,4. Whilst the NHS currently depends on traditional, paper-based, clinical records, there is a recommendation to improve communication using these systems before electronic systems are introduced⁵. The aim of this study is to improve the transfer of patient based information between healthcare professionals and to ensure that the development of such systems can be incorporated into the emerging electronic culture.

Development of a multidisciplinary method of communication
Exploratory work was initially undertaken to describe current methods of communication and identify problems. This involved a combination of methods including one-to-one interviews with various healthcare professionals (HCPs) and observations of communication during the first two days of patients' admissions. The findings were presented to a multidisciplinary (MD) group to develop a method of communication within secondary care, the effectiveness of which is to be tested through multiple outcome measures.

During the initial stages of the study, all HCPs identified problems with MD communication, including too many methods and no standard approach. A joint case note that contains important patient details and contact numbers of all involved in the care of a specific patient was suggested and presented to the MD group. This concept was considered essential in the emerging culture of governance. This will form the basis of an intervention, easy to implement in the emerging electronic patient record.

Using a combination of qualitative and quantitative methods, the effects of the intervention will be assessed; this triangulation of methods will ensure credibility of the findings. Evaluation will comprise attitudinal assessment through the development of a tool from earlier stages to assess the HCPs' perceptions of the joint case note. A content analysis will assess the usability of the joint case note quantitatively, whilst focus groups will be used to assess their perceptions qualitatively.

Discussion
There is a need for improved communication between HCPs, an effective forum where they can acknowledge each other's interventions, which is essential for the NHS agenda of governance. Effective communication requires effective teamwork between professionals and patients and it is essential that this culture is fully in place. By improving information management, for example through clinical records, it will become more feasible to implement such changes in the NHS. This abstract describes the development processes, we aim to present preliminary findings at the conference.

References

1. Department of Health "The New NHS: Modern, dependable" HMSO 1998
2. Department of Health "The NHS: A First Class Service" HMSO 1999
3. Duggan C., Hough J., Bates I. "Discrepancies in prescribing- where do they occur?" Pharmaceutical Journal; 256: Jan 13 1996 65-67.
4. Duggan C., Hough J., Feldman R., Bates I. "Reducing adverse prescribing discrepancies following hospital discharge". International Journal of Pharmacy Practice 6: 77-82.
5. The Audit Commission. "Setting the Records Straight" HMSO 1995.