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Conclusion A high proportion of inpatients in this regional hospital setting had difficulty independently participating in communication activities associated with health care. Self-reporting of communication needs was not consistently reliable in identifying when assistance is required. Patients with communication disability have been shown to be at greater risk of adverse events in hospital. Individual health care workers and health care services need to consider a universal precautions approach to communication practices in health care to optimise the health outcomes for all patients. Health care delivery is complicated and health care providers universally endeavour to provide quality care. This study adds to the literature that has shown that many patients require assistance with communication and targeted health literacy strategies to achieve best health outcomes should be considered. Acknowledgements We would like to acknowledge and thank Robyn O’Halloran for her generosity in allowing us to use her work. Also to the Speech Pathology Department and support of Bendigo Health in encouraging clinicians to participate in research. References Agency for Healthcare Research and Quality (AHRQ). (2010). AHRQ health literacy universal precautions toolkit . Retrieved from https://www.ahrq.gov/professionals/quality-patient- safety/quality-resources/tools/literacy-toolkit/index.html American Speech-Language Hearing Association. (2018). Cognitive-communication referral guidelines for adults . Retrieved from https://www.asha.org/slp/cognitive-referral/ American Speech-Language-Hearing Association. (2003). Evaluating and treating communication and cognitive disorders: approaches to referral and collaboration for speech-language pathology and clinical neuropsychology [Technical report]. Retrieved from https:// asha.org/policy/TR2003-00137/ Australian Bureau of Statistics (ABS). (2015). 4430.0 disability, ageing and carers, Australia: Summary of findings, 2015 . Retrieved from https://www.abs.gov.au/ ausstats/abs@.nsf/Latestproducts/4430.0Main%20Feature s152015?opendocument&tabname=Summary&prodno=44 30.0&issue=2015&num=&view= Australian Bureau of Statistics (ABS). (2008). 4228.0 Adult literacy and life skills: Summary results, Australia . Retrieved from https://www.ausstats.abs.gov.au/ausstats/ subscriber.nsf/0/B22A471C221C7BADCA2573CA00207F1 0/$File/42280_2006%20(reissue).pdf Australian Commission on Safety and Quality in Health Care. (2015). Health literacy: A summary for clinicians . Retrieved from https://www.safetyandquality.gov.au/sites/default/files/ migrated/Health-literacy-a-summary-for-clinicians.pdf Australian Commission on Safety and Quality in Health Care. (2018). Australian sentinel events list . Retrieved from https://www.safetyandquality.gov.au/our-work/indicators/ australian-sentinel-events-list/ Bartlett, G., Blais, T., Tamblyn, R., Clermont, R, & MacGibbon, B. (2008). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Canadian Medical Association Journal ,

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Correspondence to: Jacqui McCrabb Bendigo Health PO Box 126, Bendigo 3552 phone: 0439825019 email: jmccrabb@bendigohealth.org.au

communication in healthcare settings: New opportunities for alternative and augmentative communication. Alternative and Augmentative Communication , 32 (1), 69–79. doi:10. 3109/07434618.2015.1125947

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