Appendix.

Nurse-Physician Communication - Nurse Interview

Patient ID Number ______

Nurse ID Number______Date of Interview______

  1. Regarding (insert patient name), what is the main diagnosis (or problem) that caused this patient to be admitted to the hospital?

Don’t know
The next several questions relate to activities of your patient’s hospital care that occurred today or are planned for your patient today.
  1. What tests has the patient had today or are planned for the patient today (aside from blood tests)? For example, is the patient planned for an echocardiogram, CT scan or other types of test? (other eg; stress tests, vascular lab tests, PFTs, CT scans, MRI, Xrays, etc)

None
Don’t know
  1. What procedures or surgeries have occurred today or are planned for this patient today? (eg. invasive procedures like EGD, cardiac cath, ERCP, TEE, PICC line, central line, thoracentesis, vascath, etc)

None
Don’t know
  1. What changes to his/her medications occurred today or are planned for today?

None
Don’t know
  1. What consulting services have seen the patient today or will be seeing this patient today? (Physician consulting services, do not include physical or occupational therapy)

None
Don’t know
  1. What are the names of this patient’s doctors in the hospital?

Don’t know
  1. (For each physician identified), what is his/her role? Is he/she an intern, resident or an attending physician?
/ Name / Role (circle)
Att R I
Att R I
Att R I
  1. Have you discussed this patient’s plan of care with his/her physician(s) today? (circle one)
/ Yes No
  1. If yes, how did you discuss the patient’s plan of care? (if other, please enter type)
/ Face to face conversation
Phone conversation
Text-page exchange
Other -
  1. How long do you expect this patient to be in the hospital? (circle one)
/ Leaving today
1 more day
2 more days
3 more days
4 more days
>4 more days
Don’t know
I have just a few more questions which relate to you.
  1. What is your age?

  1. Gender? (circle one)
/ Male Female
  1. What is your race/ethnicity? (circle one)
/ White Asian Latino Afr Amer Other
  1. What year did you finish nursing school?

  1. How long have you been at NMH?

  1. How many patients were you caring for at the start of the day?

Nurse-Physician Communication - Physician Interview

Patient ID Number ______

Physician ID Number______Date of Interview______

  1. Regarding (insert patient name), what is the main diagnosis (or problem) that caused this patient to be admitted to the hospital?

The next several questions relate to activities of your patient’s hospital care that occurred today or are planned for your patient today.
  1. What tests has the patient had today or are planned for the patient today (aside from blood tests)? For example, is the patient planned for an echocardiogram, CT scan or other types of test? (other eg; stress tests, vascular lab tests, PFTs, CT scans, MRI, Xrays, etc)

None
Don’t know
  1. What procedures or surgeries have occurred today or are planned for this patient today? (eg. invasive procedures like EGD, cardiac cath, ERCP, TEE, PICC line, central line, thoracentesis, vascath, etc)

None
Don’t know
  1. What changes to his/her medications have occurred or are planned for today?

None
Don’t know
  1. What consulting services have seen the patient today or will be seeing this patient today? (Physician consulting services - Do not include physical or occupational therapy)

None
Don’t know
  1. What is the name of this patient’s nurse?

Don’t know
  1. Have you or one of the other physicians taking care of the patient discussed this patient’s plan of care with his/her nurse today? (circle one)
/ Yes No
  1. If yes, how did you discuss the patient’s plan of care? (if other, please enter type)
/ Face to face conversation
Phone conversation
Text-page exchange
Other -
  1. How long do you expect this patient to be in the hospital? (circle one)
/ Leaving today
1 more day
2 more days
3 more days
4 more days
>4 more days
Don’t know
I have just a few more questions which relate to you.
  1. What is your age?

  1. Gender? (circle one)
/ Male Female
  1. What is your race/ethnicity? (circle one)
/ White Asian Latino Afr Amer Other
  1. What year did you finish medical school?

  1. How long have you been at NMH?

  1. How many patients were you caring for at the start of the day?