The use of a daily goals sheet to improve communication in the paediatric intensive care unit.

OBJECTIVE: To assess the impact of the implementation of a daily goals sheet upon nursing perception of communication in an academic, tertiary care paediatric intensive care unit (PICU). DESIGN: Prospective, longitudinal, before-and-after intervention surveys. SETTING: University affiliated 12-bed PICU. SUBJECTS: Bedside nurses. INTERVENTIONS: A questionnaire was administered to PICU nurses addressing their perception of communication. Following this questionnaire, the use of a daily goals sheet was instituted. A second questionnaire was administered one year later. Mann-Whitney Rank Sum Test was used to compare differences of the graded outcome variables. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the perception of communication taken from a nursing perspective. Eighty-five percent of nurses felt the daily goals sheet led to improved communication between physicians and nurses in the PICU. All questions related to communication demonstrated a positive influence of the goals sheet, with the perception of the PICU staff working as a team reaching statistical significance (p=0.05). The perception of the care of one surgical service being attending physician directed also significantly improved after the institution of the goals sheet (p=0.04). CONCLUSION: The institution of a daily goals sheet led to an improvement in nursing perception of communication. Future studies are required to determine if this change in process has a demonstrable effect on health care outcomes of critically ill children, or whether this tool can have the same beneficial effects in other academic and non-academic PICUs.     

Improving communication in the ICU using daily goals

BACKGROUND: Clear communication is imperative if teams in any industry expect to make improvements. An estimated 85% of errors across industries result from communication failures. PURPOSE: The purpose of this study was to evaluate and improve the effectiveness of communication during patient care rounds in the intensive care unit (ICU) using a daily goals form. DESIGN: We conducted a prospective cohort study in collaboration with the Volunteer Hospital Association (VHA), Institute for Healthcare Improvement (IHI), and Johns Hopkins Hospital's (JHH) 16-bed surgical oncology ICU. All patients admitted to the ICU were eligible. Main outcome variables were ICU length of stay (LOS) and percent of ICU residents and nurses who understood the goals of care for patients in the ICU. Baseline measurements were compared with measurements of understanding after implementation of a daily goals form. RESULTS: At baseline, less than 10% of residents and nurses understood the goals of care for the day. After implementing the daily goals form, greater than 95% of nurses and residents understood the goals of care for the day. After implementation of the daily goals form, ICU LOS decreased from a mean of 2.2 days to 1.1 days. CONCLUSION: Implementing the daily goals form resulted in a significant improvement in the percent of residents and nurses who understood the goals of care for the day and a reduction in ICU LOS. The use of the daily goals form has broad applicability in acute care medicine.     

Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses.

BACKGROUND: Improving communication and collaboration among doctors and nurses can improve satisfaction among participants and improve patients' satisfaction and quality of care. OBJECTIVE: To determine the impact of a multidisciplinary intervention on communication and collaboration among doctors and nurses on an acute inpatient medical unit. METHODS: During a 2-year period, an intervention unit was created that differed from the control unit by the addition of a nurse practitioner to each inpatient medical team, the appointment of a hospitalist medical director, and the institution of daily multidisciplinary rounds. Surveys about communication and collaboration were administered to personnel in both units. Physicians were surveyed at the completion of each rotation on the unit; nurses, biannually. RESULTS: Response rates for house staff (n = 111), attending physicians (n = 45), and nurses (n = 123) were 58%, 69%, and 91%, respectively. Physicians in the intervention group reported greater collaboration with nurses than did physicians in the control group (P < .001); the largest effect was among the residents. Physicians in the intervention group reported better collaboration with the nurse practitioners than with the staff nurses (P < .001). Physicians in the intervention group also reported better communication with fellow physicians than did physicians in the control group (P = .006). Nurses in both groups reported similar levels of communication (P = .59) and collaboration (P = .47) with physicians. Nurses in the intervention group reported better communication with nurse practitioners than with physicians (P < .001). CONCLUSIONS: The multidisciplinary intervention resulted in better communication and collaboration among the participants.     

Improving nurse-physician communication and satisfaction in the intensive care unit with a daily goals worksheet.

OBJECTIVE: To evaluate the effect of a standardized worksheet on physicians' and nurses' perceptions of their understanding of goals of care and on patients' length of stay in an intensive care unit. METHODS: A worksheet was completed daily during multidisciplinary rounds and was posted at each bedside in the medical intensive care unit at Beth Israel Medical Center in New York. Information recorded included tests or procedures, medications, sedation, analgesia, catheters, consultations, nutrition, mobilization, family discussions, consents, and disposition. Attending physicians, residents, and nurses completed a questionnaire before implementation of the worksheet and 3 times afterwards. Responses were scored on a 5-point scale (1 = understand nothing, 5 = completely understand). Continuous variables were analyzed by using a t test; categorical variables, by using a chi(2) test. RESULTS: Before the worksheet was implemented, scores for understanding goals were 3.9 for nurses and 4.6 for physicians. Scores increased to 4.8 for nurses (P = .001) and 4.9 for physicians (P = .03) 6 weeks later, an improvement that remained at 9 months. Both groups showed significant improvement in communication scores that lasted for 9 months. Most responders wanted to continue using the worksheet. During the study, the mean stay in the unit was 4.3 days, down from 6.4 days for the analogous 9-month period in the preceding year (P= .02). CONCLUSION: Nurses' and physicians' perceptions of their understanding of the goals of care and of communication between them were improved and stays in the unit were shortened when the worksheet was used.     

Nurses’ and Physicians’ Perspectives on Text-Based Postpartum Blood Pressure Monitoring

Self-monitoring of blood pressure (BP) and using text messages to communicate values with health care providers may be a viable alternative to in-person visits to obtain postpartum BP measurements. This study was conducted to understand perspectives of nurses and physicians who have used text-based postpartum BP monitoring. Nurses and physicians who implemented text-based postpartum BP monitoring programs participated in a survey focused on perceived quality and an interview focused on perceived program advantages, disadvantages, and implementation considerations. Participants (n = 5) report that these methods are safe and ease the burden of obtaining high-quality care for this high-risk vulnerable population.     

Relational coordination among nurses and other providers: impact on the quality of patient care

havens d.s ., vasey j. , gittell j.h . & lin w-t . (2010) Journal of Nursing Management 18, 926–937
Relational coordination among nurses and other providers: impact on the quality of patient care Aim The present study examined nurse reports of relational coordination between nurses and other providers and the impact of relational coordination on patient care quality. Background While communication between providers has been traditionally considered important to improve quality, relational coordination extends this view, emphasising the value of high-quality relationships exemplified by shared goals, shared knowledge and mutual respect; and high-quality communication that is timely, frequent, accurate and problem-solving. Methods Direct care registered nurses (RNs) (n = 747) completed surveys to assess relational coordination across five provider functions and six types of patient care units. Nurses also reported perceptions about patient care quality. Results In all analyses, relational coordination between nurses and other providers was significantly related to overall quality, in the expected directions. As relational coordination increased, nurses reported decreases in adverse events such as hospital-acquired infections and medication errors. Conclusions Enhancing relational coordination between nurses and other providers is central to improving the quality of patient care. Implications for nurse managers and new knowledge The emerging theory of relational coordination provides a useful new research-based framework for managers to use to improve provider relationships, communication and the quality of care.     

Interdisciplinary preoperative patient education in cardiac surgery

BACKGROUND: In 1998, we carried out a study of interdisciplinary preoperative education in cardiac surgery given by nurses, physicians and health educators. Overlaps were found in gathering and providing information by physicians, nurses and health educators, and gaps were found in providing psychosocial information and emotional support. Based on these findings, an information protocol was developed. AIM: This paper reports a study examining the effects of the implementation of the information protocol on the content and process of preoperative education. METHODS: Dialogues between health educators and patients were videotaped at the preoperative clinic (n = 54) and on the day of admission (n = 53), and analysed using a checklist of 123 specific topics. RESULTS: The information given by health educators at the outpatient clinic and on the day of admission accorded with the information protocol to a large extent. There was also an increase in the number of psychosocial issues raised. Nurses raised significantly more psychosocial issues in comparison with before implementation of the protocol. After implementation, patients spent approximately 3 minutes less talking with the health educator and about 7 minutes less talking with a nurse. This suggests that on the day of admission a more time-efficient co-ordination in patient education was achieved. CONCLUSIONS: Implementation of the information protocol led to a better interdisciplinary division of labour. The education is tailored more to the needs of the patient, and psychosocial items are mentioned more frequently. This straightforward intervention gave very positive results. Inconsistencies, gaps and overlaps in information provision can be avoided by the unambiguous delineation of responsibilities and tasks in information provision by different health care providers.     

Is staff well-being and communication enhanced by multidisciplinary work shift evaluations?

Objective To study the implementation of multidisciplinary structured work shift evaluations at a pediatric intensive care unit (PICU) to enhance team communication.Design and setting Prospective, repeated measurements design, comparison of pre/post measurements and process measures in a Dutch tertiary care, university-affiliated PICU.Participants All 61 PICU staff members.Interventions Implementing multidisciplinary structured work shift evaluations. Before the implementation phase the PICU team received feedback training and eight participants (four physicians, four nurses) were trained as work shift evaluation leader.Measurements and results Outcome measures covered: (a) quality and process of the implementation through prestructured checklists during the 3 months of implementation, (b) a subjective evaluation of a feedback training on team communication as anticipated action and on the level of communication (about patients and with colleagues), and (c) emotional exhaustion complaints and work-related fatigue. The interdisciplinary structured work shift evaluations were implemented successfully as planned during the work shift; all staff were trained ahead, and the process was followed almost completely. Almost two-thirds (62%) of the staff felt a positive influence on team communication. Almost all staff members (92%) were satisfied regarding communication with their colleagues after the intervention, compared to 76% before. Emotional exhaustion in the PICU team decreased significantly after the implementation, but no differences in work-related fatigue levels were found.Conclusions As organizational change the implementation of a multidisciplinary structured work shift evaluation at a PICU was successful and team communication improved. Emotional exhaustion decreased during the study period.This study was made possible by support from the Social Fund for the Knowledge Sector (SoFoKles), Utrecht, The Netherlands     

Patient and provider perspectives on reducing risk of harm in primary health care: a qualitative questionnaire study in Sweden

Abstract

Objective: To explore how patients, that had experienced harm in primary care, and how primary providers and practice managers understood reasons for harm and possibilities to reduce risk of harm.

Design: Inductive qualitative analysis of structured questionnaires with free text answers.

Setting: Primary health care in Sweden.

Patients/subjects: Patients (n?=?22) who had experienced preventable harm in primary health care, and primary care providers and practice managers, including 15 physicians, 20 nurses and 24 practice managers.

Main outcome measures: Categories and overarching themes from the qualitative analysis.

Results: The three categories identified as important for safety were continuity of care, communication and competence. With flaws in these, risks were thought to be greater and if these were strengthened the risks could be reduced. The overarching theme for the patient was the experience of being neglected, like not having been properly examined. The overarching theme for primary care providers and practice managers was lack of continuity of care.

Conclusion: Primary care providers, practice managers and patients understood the risks and how to reduce the risks of patient safety problems as related to three main categories: continuity of care, communication and competence. Future work towards a safer primary health care could therefore benefit from focusing on these areas.

• Key points

• Current awareness:

• ??Patients and primary care providers are rather untapped sources of knowledge regarding patient safety in primary health care.

• Main statements:

• ??Patients understood the risk of harm as stemming from that they were not properly examined.

• ??Primary care providers understood the risk of harm to a great extent as stemming from poor continuity of care.

• ??Patients, primary care providers and practice managers believed continuity, communication and competence play an important role in reducing risks.

     

The nurse--a resource in hypertension care

AIM OF THE STUDY: To explore the content and structure of communication between patient and nurse at follow-up appointments concerning hypertension. BACKGROUND: Hypertension is a chronic condition and calls for co-operation between health care providers and patients over a long period of time. One important purpose of the follow-up consultations is to transfer knowledge between patients and health care providers in order to empower patients. This is an important determinant of the quality of care. DESIGN/METHODS: The study was based on 20 audio-recordings of actual follow-up appointments and was approved by ethics committees. The consultations took place at four different health care units for hypertensive patients. FINDINGS: The average length of consultations was 18 minutes. In the consultations, patients initiated an average of eight new topics and nurses an average of 20. All nurses talked with patients about life style. Compared with previous studies of follow-ups with physicians, consultations with nurses addressed lifestyle factors and adherence to treatment to a higher degree. It was also observed that patients were more actively involved in interaction with nurses compared with the follow-ups with physicians. CONCLUSIONS: Active patient participation in care is a critical factor in improving adherence to treatment. It would be of value to develop and assess a more patient-centred organization of hypertension care and thereby more individualized hypertension treatment. Nurses may have a pivot role in such care.     

Make No Assumptions: Communication Between Persons With Disabilities and Clinicians

Fundamentally improving health care quality requires providing care that respects patients' preferences, needs, and values. This goal holds special resonance for persons with disabilities, many of whom find others defining and circumscribing their lives and opportunities. Achieving patient centeredness demands open communication between patients and clinicians, unhampered by prior and often erroneous assumptions about patients' goals, aspirations, and abilities. Building on this communication, optimal care involves collaboration between patients and clinicians, each bringing his or her particular expertise to the table. Interviews with individuals with diverse disabilities revealed a common theme of faulty communication between patients and clinicians. Some shortfalls relate to basic failures to accommodate communication needs, whereas others result from clinicians' erroneous perceptions of medical aspects of persons' underlying conditions, the role of assistive technologies, and how disability affects people's daily lives. Crafting collaborative care partnerships between patients and clinicians requires transforming traditional patient-clinician relationships. Following two basic precepts immeasurably improves communication between clinicians and patients with disabilities: first, make no assumptions, and second, just ask patients about their needs and preferences.     

Physicians'' and nurses'' perceptions of patient involvement in myocardial infarction care

BACKGROUND: Patients' involvement in their healthcare has been associated with better health outcomes. However, few studies have examined whether patient involvement affects the work of healthcare professionals. A better understanding of professionals' views and behaviour is necessary for improving clinical practice and optimizing patient involvement. AIM: To measure perceptions and behaviour regarding patient involvement among physicians and nursing staff caring for patients with acute myocardial infarction. METHODS: A questionnaire study conducted in 2005 among cardiology staff at twelve Swedish hospitals. The questionnaire included six scales measuring staff views and behaviour. RESULTS: Physicians, registered nurses, and practical nurses did not differ significantly in their views of patient involvement, but did differ significantly in behaviour (p<.001). All three groups felt that an actively involved patient enriched their work, at the same time increasing their work load and taking time from other tasks. Physicians discussed daily activities and lifestyle changes with myocardial infarction patients before hospital discharge to a greater extent than nursing staff (p<.001). CONCLUSION: Physicians and registered nurses viewed time constraints as a hinder for patient involvement, while practical nurses felt unsure in communicating with patients. Considering these organizational and professional issues may improve patient involvement and health outcomes in myocardial infarction care.     

“Acute caring” in the emergency department

The aim of this essay was to discuss the ways in which the dynamics of interprofessional communication and collaboration among healthcare providers ultimately affect patient quality of care in the acute setting. Interprofessionalism describes a care model whereby health providers use complementary skills, knowledge and competencies to provide quality care to a group of patients. These interactions are characterized by trust, respect and an understanding of each other's skill and knowledge. At its best, the interprofessional care model has made great strides in the amelioration of patient outcomes, including reduction in negative outcomes, decreased health access needs and increased patient satisfaction. However, challenges with regard to communication and implementation have translated to a steep learning curve for healthcare providers. As such, a new-found emphasis has been placed on interprofessional education for today's healthcare students with the goal of promoting a more efficient and collaborative philosophy for tomorrow's healthcare teams.     

HIPAA and talking with family caregivers: what does the law really say?

The Health Insurance Portability and Accountability Act of 1996 (PL 104-191), known as HIPAA, has confused and unnecessarily alarmed many conscientious health care providers. Nurses in particular are likely to be on the front line of family caregivers' inquiries, because physicians are often difficult to reach and because family caregivers look to nurses as sources of reliable information. A major retraining of health care providers at all levels is needed to dampen the "HIPAA scare" and clarify what HIPAA does and does not say about communication with family caregivers.