HIM 350 Module 3 Clinical Communication Short Paper Example

Who Needs to Know, and How Fast? Clinical Communication at Sandstone Behavioral Health

[Student Name]

Southern New Hampshire University

HIM 350: Communication and Technologies

Module Three Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Who Needs to Know, and How Fast? Clinical Communication at Sandstone Behavioral Health

Most talk about healthcare communication technology focuses on patients. Yet much of the risk lies in communication between staff: a crisis worker who cannot reach a therapist, a discharge summary that sits unread or a message that gets lost among hundreds of automated notices. At Sandstone Behavioral Health, a missed handoff last spring meant a client discharged from a psychiatric hospital waited 16 days for a follow-up appointment. This paper maps how Sandstone's clinicians communicate, reviews evidence on alternatives and recommends changes.

Current Channels

Sandstone's clinicians use four main channels. The mobile crisis team carries one-way pagers and calls back from personal phones. Outpatient clinicians use the record system's in-basket for messages, results and refill requests. Hospital discharge notices arrive by fax or through the state health information exchange and are routed to intake staff. Urgent coordination happens by phone, often without any record of what was said. No single channel is reliable for time-sensitive information.

Table 1. Clinical Communication Channels at Sandstone

Note. Compiled by the author from staff interviews and message logs.

Evidence on Secure Messaging

Przybylo et al. (2014) conducted a cluster-randomized trial on inpatient medicine teams at an academic hospital, adding a secure group messaging application for smartphones to traditional one-way paging. Team members using the application rated it significantly more effective than paging for communicating clearly and efficiently and for fitting into workflow during rounds and discharge, and reported higher overall satisfaction. The study measured perceptions rather than patient outcomes, but it supports replacing callback-dependent paging with secure, detailed messaging for teams like Sandstone's crisis unit.

When Messages Become Noise

More messaging is not always better. Tai-Seale et al. (2019) studied physicians in a large multispecialty group and found that those receiving more in-basket messages generated automatically by the record system, such as notifications and reminders, were more likely to report burnout and plans to reduce clinical time. At Sandstone, a psychiatrist's in-basket averages more than 150 items a day, most automated. Important messages, such as a hospital discharge notice, can drown in that volume.

Evidence on Structured Handoffs

Handoffs transfer responsibility for a patient between clinicians or settings. Starmer et al. (2014) introduced I-PASS, a handoff routine whose letters prompt the sender to rate how sick the patient is, summarize the case, list tasks and flag contingencies, and then ask the receiver to restate the plan, in nine pediatric residency programs. Afterward, medical errors dropped about a quarter and preventable harms nearly a third, and handoffs took no longer than before. The setting differs from community behavioral health, but the principle of a consistent structure with confirmation by the receiver transfers well.

The Missed Discharge Follow-Up

In the case that prompted this paper, a psychiatric hospital sent a discharge notice by fax on a Friday afternoon. Intake staff scanned it Monday and routed it to the assigned therapist's in-basket, where it sat among automated notices while the therapist was on leave. No one confirmed receipt. The client's first appointment came 16 days after discharge, beyond the seven-day follow-up standard that quality measures use for behavioral health hospitalizations. The failure involved channel, volume and the absence of a handoff structure.

What Belongs in the Record

Clinical communication raises a documentation question central to HIM: which messages are part of the legal health record? Sandstone's policy treats messages that contain clinical decisions, instructions or information used in care as part of the record, while routine scheduling logistics are business records. Phone conversations that change a treatment plan must be summarized in a note. Secure messaging platforms must allow clinically relevant messages to be saved to the chart, and retention rules must cover them.

The Rural Coverage Problem

Any technology choice must work in Sandstone's service area, where cellular coverage disappears along stretches of county road and some clients live beyond broadband. Crisis workers report that pagers, which use a separate network, reach them in places phones do not. That is why the recommendation below keeps pagers as backup rather than eliminating them. The crisis team also needs a way to document a field contact when no signal is available, so the secure messaging application must store messages offline and send them when a connection returns.

Communicating With Outside Partners

Many of Sandstone's most important handoffs involve other organizations: psychiatric hospitals, emergency departments, jails and primary care clinics. These partners use different record systems and communication habits. Sandstone plans to publish a single intake line and a secure direct messaging address for referrals and discharge notices, ask the two hospitals that discharge most of its clients to call intake as well as fax and share a one-page handoff form that covers risk, medications, the next appointment and who to call. A shared form works across systems when shared software does not.

Recommendations

Four changes follow. Replace crisis team pagers with a secure messaging application under a business associate agreement, with pagers kept as backup in areas without cellular coverage. Filter automated in-basket notices into separate folders so discharge notices and clinical messages appear first. Adopt a structured discharge handoff: intake calls the hospital within one business day, confirms the follow-up appointment and documents it using a short template modeled on I-PASS elements. And require a same-day note for phone conversations that change care.

Measuring Improvement

Progress will be tracked through the share of hospital discharges with follow-up within seven days, currently 61%, the median time from discharge notice to confirmed appointment, crisis team callback times and clinician-reported in-basket burden in an annual survey. The HIM department will also audit whether clinically relevant secure messages are saved to the chart.

Conclusion

Sandstone's clinicians communicate through tools that were adequate one by one but fail together, as the 16-day follow-up showed. Evidence supports secure messaging, disciplined control of automated messages and structured handoffs. Together with clear rules about which messages belong in the record, these changes can make sure the right person knows the right thing in time.

References

Przybylo, J. A., Wang, A., Loftus, P., Evans, K. H., Chu, I., & Shieh, L. (2014). Smarter hospital communication: Secure smartphone text messaging improves provider satisfaction and perception of efficacy, workflow. Journal of Hospital Medicine, 9(9), 573-578. https://doi.org/10.1002/jhm.2228

Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O'Toole, J. K., Solan, L. G., Aylor, M., . . . Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803-1812. https://doi.org/10.1056/NEJMsa1405556

Tai-Seale, M., Dillon, E. C., Yang, Y., Nordgren, R., Steinberg, R. L., Nauenberg, T., Lee, T. C., Meehan, A., Li, J., Chan, A. S., & Frosch, D. L. (2019). Physicians' well-being linked to in-basket messages generated by algorithms in electronic health records. Health Affairs, 38(7), 1073-1078. https://doi.org/10.1377/hlthaff.2018.05509