A study of provider-caregiver communication in paediatric ambulatory care.

Challenges in communication have been identified as major contributors to medical error in paediatric care (1). Communication, which includes establishing rapport with the patient and family and instilling a sense of trust, as well as conveying information regarding a diagnosis or treatment plan, affects compliance and, ultimately, outcome (2). In a study (3) of hospital characteristics associated with parental views of paediatric inpatient care, parents considered communication to be strongly associated with the quality of the inpatient care of their children. Waisman et al (4) found that 20% of parents did not understand emergency department discharge instructions. Lack of comprehension of discharge instructions was noted in previous studies of postdischarge instructions (5,6). Language barriers have also been associated with errors in interpretation of medical instructions in paediatric ambulatory care (7). At The Hospital for Sick Children in Toronto, Ontario, the Division of Infectious Diseases (ID) conducts three separate clinics, each with unique patient and staff characteristics. The purpose of the present study was to identify and compare communication issues in these three paediatric outpatient clinics that may affect patient safety.