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Put a Face to a Name: A Randomized Controlled Trial Evaluating the Impact of Providing Clinician Photographs on Inpatients' Recall

Published:September 24, 2014DOI:https://doi.org/10.1016/j.amjmed.2014.08.035

      Abstract

      Background

      Inpatients are visited by many health care providers daily; many cannot remember the name of even one member of their clinical care team. We provided inpatients with photographs of their clinicians and evaluated the impact on patient recall and communication with their health care providers.

      Methods

      A concealed allocation, randomized controlled trial (ClinicalTrials.gov NCT01658644) was conducted between September 2012 and April 2013 in the general internal medicine wards of a large teaching hospital in Toronto, Canada. Consenting patients were randomized into 3 groups: the control group received the current standard of care; the second group received handouts with the names and roles of their clinical care team; and the third group received handouts with the names, roles, and photographs of their clinical care team. Before discharge, patients completed a survey on their ability to recall their clinicians and were asked to rate the quality of communication with their care team.

      Results

      Of the 186 patients (mean age 61 years, female = 44%) who completed surveys (control n = 60; names n = 65; photos n = 61), those receiving photos in the handout correctly identified significantly more clinicians by photograph (P = .001) and recalled more names (P = .002) than patients assigned to the control group. Regarding the perceived quality of communication, the results did not show differences between the control and intervention groups.

      Conclusion

      In this era of patient-centered care, providing patients with more information about who is directly involved with their health care appears to be warranted.

      Keywords

      Clinical Significance
      • Frequent clinical staff rotations are a challenge for patients and their family members.
      • Helping patients identify their care team members and respective roles will improve the patient experience.
      • Patients receiving photographs of their clinicians recalled significantly more care team members.
      • Improved patient–provider communication results in increased patient understanding of their condition and adherence to their care plan.
      Health care is currently characterized as “more to do, more to know and more people involved than ever before.”
      • Committee on Quality of Health Care in America, Institute of Medicine
      Crossing the Quality Chasm: A New Health System for the 21st Century.
      Due to both complexity and frequent rotation of the care team members, patients admitted to a teaching hospital may meet many different physicians, nurses, and therapists. For patients already vulnerable due to their medical condition, keeping track of care providers may be very difficult. Prior studies found that the majority of patients admitted to the hospital are unable to correctly identify even one of their physicians or nurses.
      • Arora V.
      • Gangireddy S.
      • Mehrotra A.
      • Ginde R.
      • Tormey M.
      • Meltzer D.
      Ability of hospitalized patients to identify their in-hospital physicians.
      • Makaryus A.N.
      • Friedman E.A.
      Does your patient know your name? An approach to enhancing patients' awareness of their caretaker's name.
      • O'Leary K.J.
      • Kulkarni N.
      • Landler M.P.
      • et al.
      Hospitalized patients' understanding of their plan of care.
      • Olson D.P.
      • Windish D.M.
      Communication discrepancies between physicians and hospitalized patients.
      Patients' inability to recognize their clinicians can have negative effects for patient–provider communication, and patient satisfaction.
      • Arora V.
      • Gangireddy S.
      • Mehrotra A.
      • Ginde R.
      • Tormey M.
      • Meltzer D.
      Ability of hospitalized patients to identify their in-hospital physicians.
      Simple interventions, such as having names written on dry-erase boards in patients' rooms, have been found to improve patients' ability to recall their clinicians but with only limited success.
      • O'Leary K.J.
      • Kulkarni N.
      • Landler M.P.
      • et al.
      Hospitalized patients' understanding of their plan of care.
      • Maniaci M.J.
      • Heckman M.G.
      • Dawson N.L.
      Increasing a patient's ability to identify his or her attending physician using a patient room display.
      There is evidence that pictures are superior in memory recall compared with other types of stimuli, such as words (names).
      • Kargopoulos P.
      • Bablekou Z.
      • Gonida E.
      Effects of face and name presentation on memory for associated verbal descriptors.
      Research shows that photographic aids can improve communication,
      • Hasebrook J.P.
      • Gremm M.
      Multimedia for vocational guidance: effects of individualized testing, videos, and photography on acceptance and recall.
      help people retain information,
      • Glenberg A.
      Memory and faces: pictures help you remember who said what.
      and diminish inaccurate appropriations of facts.
      • Kargopoulos P.
      • Bablekou Z.
      • Gonida E.
      Effects of face and name presentation on memory for associated verbal descriptors.
      • Glenberg A.
      Memory and faces: pictures help you remember who said what.
      • Houts P.
      • Doak C.
      • Doak L.
      • Loscalzo M.
      The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence.
      Furthermore, photographic aids have been shown to increase feelings of empathy, compassion, and understanding about a person or situation.
      • Houts P.
      • Doak C.
      • Doak L.
      • Loscalzo M.
      The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence.
      Making photographs of clinicians available to patients may increase patients' knowledge of who is responsible for their care, thereby increasing their trust and satisfaction.
      While there are a growing number of studies addressing the use of photographic aids in hospitals, most focus on reducing “wrong patient” errors or juxtaposition errors (orders placed for the wrong patient due to too many Electronic Patient Record system windows open on the same screen at once).
      • Hyman D.
      • Laire M.
      • Redmond D.
      • Kaplan D.W.
      The use of patient pictures and verification screens to reduce computerized provider order entry errors.

      Agency for Healthcare Research and Quality Healthcare. Use of photographs as second means of identifying patients on psychiatry units virtually eliminates medication errors related to misidentification (published December 2009, updated October 2013). Available at: http://www.innovations.ahrq.gov/content.aspx?id=2626. Accessed January 23, 2013.

      Two studies looked at photographs from the patient's perspective: one assessed the use of physician photographs and names in a before–after study, and the other was a cluster randomized trial.
      • Arora V.M.
      • Schaninger C.
      • D'Arcy M.
      • et al.
      Improving inpatients' identification of their doctors: use of FACE cards.
      • Simons Y.
      • Caprio T.
      • Furiasse N.
      • Kriss M.
      • Williams M.V.
      • O'Leary K.J.
      The impact of facecards on patients' knowledge, satisfaction, trust, and agreement with hospital physicians: a pilot study.
      In these studies, patients were significantly more likely to correctly identify at least one physician (attending, resident, or intern); however, both studies failed to demonstrate that photographs alone are the most influential variable on patients' recall. Additionally, the interventions used in both studies focused only on physicians, while other clinicians such as pharmacists, physiotherapists, and social workers also visit patients frequently, adding to the patient's confusion about who makes up their care team.
      Our study fills a gap in the literature by conducting a rigorous evaluation, specifically designed to measure the impact of photographs on patient recall and perceived communication within the hospital environment.
      The primary objective of this study was to determine whether providing patients with photographs of their health care team, in addition to names and roles, improves their recall of the members of their care team, compared with providing them with names and roles only, or not providing names, roles, or photographs, as per standard care.
      The secondary objective was to determine whether patients who receive photographs of their care team members perceive improved communication with their care team. This was measured by analyzing patients' responses to predetermined survey questions.

      Methods

      Setting

      The study was conducted on 2 general internal medicine wards at a large academic, urban hospital in Toronto, Canada. The wards consist of 36 beds each and are staffed by one of 2 physician services: 1) clinical teaching team or 2) hospitalist team. Teaching teams consist of one attending physician, one second- or third-year resident, 2-3 interns, and 1-2 medical students. The hospitalist unit is staffed by 2 fellows, and often an elective resident and medical student. Patients are admitted to these general internal medicine units from the emergency department or from critical care units. There are no elective admissions. In addition to the medical team, each patient's care team typically includes nurses, pharmacists, physiotherapists, occupational therapists, social workers, dietitians, speech language pathologists, and spiritual care providers.

      Trial Design

      “Put a Face to a Name” (Face2Name) is a concealed-allocation, parallel-group, randomized controlled trial listed with ClinicalTrials.gov #NCT01658644. The study consisted of a control group and 2 intervention groups. Each participant consented before enrollment and random assignment to study arms. Therefore, all participants were aware of the research focus as described in the informed consent. The research team used a computer-generated permuted-block randomization to assign patients, in a ratio of 1:1:1, to one of the 3 groups. Depending on the group to which they were randomized, the researcher provided patients with either no handout (group A), or the corresponding intervention tool: a handout with just the names and roles (Group B), or a handout with the names, roles, and photographs of their clinicians (Group C).

      Participants and Interventions

      Patients allocated to Group A, the control group, were not exposed to any intervention, receiving the standard hospital experience. Patients assigned to Group B were provided with a handout displaying the names and roles of their clinicians as well as describing the responsibilities of each role (Figure 1). Finally, patients assigned to Group C were provided with a handout displaying the names and roles of their clinicians; each name was also complemented by the corresponding team member's photograph and a description clinical role (Figure 2). Every weekday during the study period a member of the research team approached patients admitted to General Internal Medicine the previous day who met the exclusion/inclusion criteria; that is, who did not present significant confusion, delirium, or dementia, and had the ability to provide informed consent. Consented patients were randomized and received the corresponding intervention at the earliest possible time after enrollment in the study. Patients who received handouts were encouraged to use them as often as desired during their hospital stay.
      Figure thumbnail gr1
      Figure 1Group B sample handout (Names). Patients randomly assigned to the Group B study arm received a paper handout with the names and roles of their clinical care team members.
      Figure thumbnail gr2
      Figure 2Group C sample handout (Photos and Names). Patients randomly assigned to the Group C study arm received a paper handout with the names, roles, and photos of their clinical care team members.

      Sample Size

      Using estimates from previous literature,
      • O'Leary K.J.
      • Kulkarni N.
      • Landler M.P.
      • et al.
      Hospitalized patients' understanding of their plan of care.
      we calculated a desired sample size of 93 in each group, with an alpha error of 5% and beta error of 20%. Assuming a dropout rate of 8%, we set the goal for the sample size at 300 patients. Due to a lack of resources, the data collection was stopped after 256 patients were randomized.

      Data Collection

      On the day before or the day of discharge, participating patients were surveyed to test their memory recall of their team of clinicians and to evaluate their perception of the quality of communication with their clinicians. Questions in the structured survey instrument were derived from a review of literature,
      • O'Leary K.J.
      • Kulkarni N.
      • Landler M.P.
      • et al.
      Hospitalized patients' understanding of their plan of care.
      through team discussions, and were based on Hospital Consumer Assessment of Healthcare Providers and Systems,

      Hospital Consumer Assessment of Healthcare Providers and Systems. Hospital Care Quality Information from the Consumer Perspective (HCAHPS). Available at: http://www.hcahpsonline.org. Accessed February 14, 2012.

      a validated national standard for assessing patients' perspectives on hospital care. The survey tool was pilot tested with 12 patients to evaluate whether the questions were clear, easy to follow, and allowed for honest response. As a result, the number of questions was reduced and the sequence of the questions and wording was revised (Figure 3). In general, survey responses were filled in by the patients themselves; however, if the patient required physical assistance, a family member or the researcher aided in the completion of the survey.
      Figure thumbnail gr3
      Figure 3Pages 2 and 3 of the questionnaire tool. The Figure shows pages 2 and 3 of the questionnaire provided to patients before discharge. Page 2 tests patients recall of their clinical care team members; page 3 asks about patients' perceived satisfaction with patient-provider communication.

      Statistical Methods

      Statistical analyses were conducted using IBM SPSS (IBM, Armonk, NY). Nonparametric independent sample tests were used to compare the distribution across study arms and other independent variables for the primary and secondary outcomes. Our primary outcome, patient recall, was informed by responses to question #3 of the survey tool. Patient recall was measured by the number of photographs correctly identified, names correctly remembered, and clinician roles correctly assigned. The Kruskal-Wallis test was used to determine if there was significance across the distribution of the 3 study arms for each of the 3 measures. With a 95% confidence level, P values < .05 were considered statistically significant. For results that were statistically significant, Mann-Whitney (2 independent variables) test was used to compare the means between 2 trial groups at a time. Patients' perception of communication quality, our secondary outcome, was evaluated using the responses to survey questions #8, #9, and #10. Good quality of communication meant that patients responded either “often” or “always” to the questions about clinicians listening carefully and clinicians explaining things in a way patients could understand, as well as rating the ease of communication as a “4” or “5” on a scale of 1-5, where 5 denotes very easy.
      Nonparametric tests were used to assess the impact on recall and quality of communication by the secondary variables (age, sex, length of stay, whether English is the patient's primary language, whether the patient is a Canadian immigrant, whether the patient had visitors during their hospital stay, and whether the patient was assigned to a teaching medical team or the hospitalist team). These analyses were used to determine if confounding factors impacted patient recall and perceived quality of communication.

      Ethics

      All study procedures were approved by the Research Ethics Board at University Health Network and the Institutional Review Board at Rutgers University.

      Results

      Eligible participants were recruited from September 2012 to May 2013. Of the 256 patients that consented, only 186 completed the survey, and 70 patients were lost due to unexpected or early discharge from the hospital. The analysis included all randomized patients that completed the survey (Group A, n = 60; Group B, n = 65; Group C, n = 61). See Figure 4 for the CONSORT Clinical Trial Flow diagram and Table 1 for a summary of the baseline data.
      Figure thumbnail gr4
      Figure 4CONSORT flow diagram for the randomized controlled trial. The flow diagram depicts the passage of participants through the randomized controlled trial in 4 stages (enrollment, intervention allocation, follow-up, and analysis). It explicitly shows the number of participants, for each study arm, included in the primary data analysis.
      Table 1Descriptive Statistics of Participants by Primary Variable (Group Assignment) and Secondary Variables
      Variable:Group A – Control (n = 60)Group B – Names (n = 65)Group C – Photos and Names (n = 61)Total (n = 186)
      Mean age (years)61606161
      Sex (female), n (%)26 (43.3%)32 (49.2%)25 (41%)83 (44.6%)
      Mean length of stay (days)3.23.43.13.3
      English primary (yes), n (%)49 (81.7%)52 (80.0%)51 (83.6%)152 (81.7%)
      Immigrant (yes), n (%)10 (16.7%)13 (20.0%)8 (13.1%)31 (16.7%)
      Visitors
      Visitors: whether the patient had visitors (including family) during their hospital stay.
      (yes), n (%)
      18 (30.0%)15 (24.6%)27 (44.3%)60 (32.3%)
      Team 1, n (%)16 (26.7%)13 (20.0%)14 (23.0%)43 (23.1%)
      Team 2, n (%)10 (16.7%)12 (18.5%)14 (23.0%)36 (19.6%)
      Team 3, n (%)11 (18.3%)15 (23.1%)14 (23.0%)40 (21.5%)
      Team 4, n (%)17 (28.3%)11 (16.9%)10 (16.4%)38 (20.4%)
      Team 5 (Hospitalist), n (%)6 (10.0%)14 (21.5%)9 (14.8%)29 (15.6%)
      Visitors: whether the patient had visitors (including family) during their hospital stay.
      There were no significant demographic differences between the study groups (Table 1). Random assignment allocated relatively equal numbers of participants to the 3 trial groups, and the number of patients assigned to different clinical teams was also comparable. Fewer patients were assigned to the hospitalist team, as admissions to this team are restricted to the hours of 8:00 am to 3:00 pm, Monday to Friday.

      Descriptive Statistics

      Of the 186 survey respondents, 30% could not initially recall a single clinician by name without being shown any visual cues (Question 1). There were 86.5% who reported finding names somewhat or very useful (Question 4), whereas 92.4% reported finding the photographs somewhat or very useful (Question 5) (Table 2). When asked which of the 2 aids would better help patients remember their clinicians, 78% responded that photographs were more useful than names (Question 6) (Table 2). A total of 83.7% of patients felt that their clinicians carefully listened to them usually or always (Question 8), and 85.9% felt that their clinicians explained things in a way they could understand usually or always (Question 9) (Table 2). Finally, 81.1% of patients rated the ease of communication with their clinicians as easy or very easy (Question 10) (Table 2).
      Table 2Summary of Survey Responses by Survey Question and Primary Variable (Group Assignment)
      Survey QuestionResponsesGroup A ControlGroup B NamesGroup C Photos and NamesTotal
      1. Please list the names of the people that took care of you that you can remember off the top of your head?Mean number of names initially recalled, before the photo page (SD)2.0 (2.4)2.5 (2.6)2.6 (2.8)2.4 (2.6)
      2. Please circle the roles of the people who you met during your stay in the hospital so far.Mean number of roles initially recalled, before the photo page (SD)4.8 (2.1)4.9 (1.8)4.8 (1.8)4.8 (1.9)
      3. For those people you met during your stay, please circle the faces you recognize and if you remember, please write their names and roles under their faces.Mean number of faces correctly circled, on the photo page (SD)2.3 (1.8)2.5 (1.9)3.6 (2.4)2.8 (2.1)
      4. Would you find a paper with the names of your clinical team useful?Not at all useful9 (15%)7 (11%)9 (15%)25 (14%)
      Somewhat useful15 (25%)18 (28%)25 (41%)58 (31%)
      Very useful36 (60%)39 (61%)27 (44%)102 (55%)
      5. Would you find a paper with the photos of your clinical care team useful?Not at all useful6 (10%)4 (6%)4 (7%)14 (8%)
      Somewhat useful18 (30%)15 (23%)16 (26%)49 (26%)
      Very useful36 (60%)45 (70%)41 (67%)122 (66%)
      6. Which tools help you better remember the people who take care of you, names or photos?Names17 (29%)12 (19%)11 (19%)40 (22%)
      Photos41 (71%)50 (81%)47 (81%)138 (78%)
      7. Did you ever receive a paper with a list of the people who take care of you? If yes, how often did you look at the paperDid not receive57 (95%)6 (9%)2 (3%)65 (35%)
      Looked at:
       Never010 (15%)2 (3%)12 (6%)
       1-4 times3 (5%)44 (68%)47 (77%)94 (51%)
       5 or more times05 (8%)10 (16%)15 (8%)
      8. During your hospital stay, how often did your care team listen carefully to you?Never05 (8%)05 (3%)
      Sometimes10 (17%)9 (14%)6 (10%)25 (14%)
      Often18 (30%)11 (17%)25 (41%)54 (29%)
      Always32 (53%)38 (60%)30 (49%)100 (54%)
      9. During your hospital stay, how often did your care team explain things in a way you could understand?Never1 (2%)1 (2%)1 (2%)3 (2%)
      Sometimes4 (7%)11 (17%)8 (13%)23 (12%)
      Often22 (37%)18 (28%)22 (36%)62 (34%)
      Always33(55%)34 (53%)30 (49%)97 (52%)
      10. On a scale from 1-5, what number would you use to rate how easy it was for you to communicate with the people who take care of you?1 (very difficult)1 (2%)4 (6%)1 (2%)6 (3%)
      22 (3%)2 (3%)2 (3%)6 (3%)
      37 (12%)9 (14%)7 (11%)23 (12%)
      417 (28%)19 (30%)18 (30%)54 (29%)

      Primary Outcome

      Patients randomized to the group that received handouts with names correctly identified significantly more (P = .01) names of clinicians than patients in the control group (Table 3). When comparing the addition of photographs to just names, results showed that patients who received handouts with photographs and names (Group C) identified significantly more (P = .04) clinicians' photographs than patients who received handouts with only names (Group B). Finally, patients in Group C recalled significantly more names (P = .002) and more photographs (P = .001) than the control group. Comparison of means revealed that patients in Group B (receiving only names) remembered, on average, one more clinician by name than the control group. Patients in Group C correctly identified one more clinician than those in Group B. Finally, patients in Group C recalled, on average, one more name and 2 more faces than patients in the control group. There were no statistically significant differences across the study arms related to patients correctly remembering clinicians' roles (Table 3).
      Table 3Mean Number of Recalled Clinicians by Primary Variable (Group Assignment) – Associated with Survey Question 3
      Primary OutcomeGroup A (Control)Group B (Names)Group C (Names + Photographs)
      Number of photographs correctly circled (mean)223 (vs control, P = .001; vs Names, P = .04)
      P-values are listed only for those results that are < .05.
      Number of names correctly identified (mean)01 (vs control, P = .01)
      P-values are listed only for those results that are < .05.
      2 (vs control, P = .002)
      P-values are listed only for those results that are < .05.
      Number of roles correctly identified (mean)112
      P-values are listed only for those results that are < .05.
      Participants' ages had an impact on the correct identification of clinician photographs (P = .04): the younger the patients, the greater number of faces recognized. There was no impact on recall by the other variables: sex, length of stay, English as primary language, being immigrant, whether patients had visitors, or whether the patient was on the resident or hospitalist team.
      With respect to the secondary objective of the study pertaining to the quality of communication, the difference between the intervention and the control arms was not significant. Additionally, there was no correlation with the confounding variables.

      Discussion

      Our study evaluated the impact of providing inpatients with photographs of their clinical care team on their recall of the care team members and on perceived patient–provider communication. We found that patients have difficulty remembering their hospital care team members, with 30% of patients being unable to recall a single clinician's name. Furthermore, we found that the number of clinicians recalled by patients was statistically significantly greater when patients were provided a memory tool. Providing only names helped recall, and providing photos and names improved recall further. We found that the interventions did not affect the perceived quality of patient–clinician communication.
      Our findings are consistent with prior studies
      • O'Leary K.J.
      • Kulkarni N.
      • Landler M.P.
      • et al.
      Hospitalized patients' understanding of their plan of care.
      • Arora V.M.
      • Schaninger C.
      • D'Arcy M.
      • et al.
      Improving inpatients' identification of their doctors: use of FACE cards.
      • Simons Y.
      • Caprio T.
      • Furiasse N.
      • Kriss M.
      • Williams M.V.
      • O'Leary K.J.
      The impact of facecards on patients' knowledge, satisfaction, trust, and agreement with hospital physicians: a pilot study.
      and add further rigor, as they were obtained from a randomized controlled trial. When compared with the current standard of care, patients provided with the names of their clinicians do a better job at remembering their clinicians' names. However, this does not help patients better recognize their clinicians by face. Patients receiving handouts with photographs do significantly better both at remembering names and at recognizing photographs of their clinical care team. The addition of photographs appears to be superior to just providing names, and represents an important aid for patients to know who is providing their care. Patients' recall has the potential to reduce uncertainty and anxiety experienced when unfamiliar people enter their hospital room. The positive effect of photographs replicated findings from studies outside health care that also found the value of imagery.
      • Kargopoulos P.
      • Bablekou Z.
      • Gonida E.
      Effects of face and name presentation on memory for associated verbal descriptors.
      • Hasebrook J.P.
      • Gremm M.
      Multimedia for vocational guidance: effects of individualized testing, videos, and photography on acceptance and recall.
      • Glenberg A.
      Memory and faces: pictures help you remember who said what.
      • Houts P.
      • Doak C.
      • Doak L.
      • Loscalzo M.
      The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence.
      It is interesting to note, however, that while providing patients with photographs increases the number of clinicians they recognize, it does not increase the number of names they recall over patients who are provided with just names. This may indicate that the medium in which the information is provided has an impact on the information recalled; in other words, text helps patients recall text (names), whereas photographs help in the recall of images (faces). This finding is especially relevant for hospitals that cater to an ethnically diverse group of patients that may speak a variety of languages, as visual images cross language barriers. Intuitively, it makes sense that patients should find it easiest to recognize faces, more challenging to recall professional roles, and finally, find it most difficult to remember names.
      We found that providing handouts with names and photos of clinicians improved recall by one clinician, which was statistically and likely clinically significant. While the intervention proved beneficial for increasing patient recall, the overall number of clinicians recognized by patients remains relatively low in all 3 dimensions (faces, names, roles). The handouts helped patients recall, on average, 2 or 3 clinicians from teams usually consisting of over 5 members. Contrary to our expectations, the intervention did not improve recall of clinicians’ roles. There is further opportunity to improve the tool or develop associated initiatives that strengthen the aids provided by the handouts.

      Limitations

      In this study, 27.3% of patients (70/256) were lost to follow-up. The reason for this high dropout rate was that randomized patients were discharged before survey administration. This reflects the rapid turnover of general medicine patients and is very close to those experienced in similar studies.
      • O'Leary K.J.
      • Kulkarni N.
      • Landler M.P.
      • et al.
      Hospitalized patients' understanding of their plan of care.
      • Simons Y.
      • Caprio T.
      • Furiasse N.
      • Kriss M.
      • Williams M.V.
      • O'Leary K.J.
      The impact of facecards on patients' knowledge, satisfaction, trust, and agreement with hospital physicians: a pilot study.
      The high rate of loss to follow-up was seen in all 3 groups and is unlikely to bias results significantly. The study did not specify visual impairment as an exclusion criterion. However, this did not impact the current study, as no patient presented with this condition. The handout was created as per scheduled rotations and shifts, and did not account for unanticipated staff visits such as fly-ins and specialists. As such, some patients may have been visited by staff not featured in their handouts. In addition, patients with extended hospital stay may have used handouts that eventually became “obsolete” throughout their stay, due to staff rotation. We do not believe that this significantly impacted the results, as the average length of stay in the study was 3.3 days, and teams attempt to discharge their patients before a large staff rotation. Because of frequent shifts in nursing staff, the handouts did not contain their names, leaving out a key member of the interprofessional team. A dynamic electronic tool that can draw on the different scheduling databases and create up-to-date handouts may help this issue.

      Future Directions

      Our intervention, the paper handout with clinicians’ photos, names, and roles, is a relatively simple way of helping patients get to know their care team. Unfortunately, it is difficult to sustain due to issues in maintaining accurate content and distribution. We propose that the intervention become a hospital-supported multi-platform electronic application that collects clinicians' photographs and information from a number of data sources and displays them organized according to patients' circle of care. Future research should entail usability studies that identify where and how the electronic tool can be used most effectively, and uncover unintended consequences. Finally, throughout the trial, hospital clinicians expressed interest in having access to the names and photographs of other staff working on their clinical teams and the ward in general. Clinician anonymity and the resulting breakdowns in interprofessional communication are often cited as main areas of improvement for medical institutions. Providing clinicians with a visual directory of their colleagues could improve interprofessional relationships and communication.

      Conclusion

      For inpatients, recognizing clinicians and knowing their names and roles can be daunting. We found that patients had improved recall of their care team if provided with photographs of the team.

      Acknowledgements

      The authors declare that they have no conflicts of interest, including financial interests, activities, relationships, and affiliations. The authors would like to acknowledge Heming Bai, David MacLean, and Elizabeth Seary for their help with data collection.

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      Linked Article

      • Statistics Gone Mad
        The American Journal of MedicineVol. 128Issue 10
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          I read with interest Appel et al's article “Put a Face to a Name: A Randomized Controlled Trial Evaluating the Impact of Providing Clinician Photographs on Inpatients' Recall.”1
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