Improving Nurse-Provider Communication and Teamwork Using a Structured Daily Huddle
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Abstract
Problem & Purpose: A significant communication problem exists between nurses and providers on a 24-bed intermediate care unit (IMC) at a large, teaching hospital in the Mid-Atlantic United States. Providers express frustrations about the high frequency of redundant and inefficient secure text messages from nurses, while nurses express frustrations in the lack of provider updates regarding the patient’s care plan. Baseline data revealed only 52.4% of patients had nurse-provider communication during morning rounds. This gap reveals a potential source for patient harm related to poor care team communication. This quality improvement project aims to implement a process for supporting structured nurse-provider daily huddles to improve nurse-provider communication and teamwork. Methods: The care team will huddle in the morning to discuss the plan of care through the support of required communication elements in the form of a checklist. Huddle data will be collected using huddle logs. A teamwork perception questionnaire will be completed by nursing staff pre- and post-intervention to evaluate changes in teamwork perception. A secure text message transaction report will be extracted for each nurse pre- and post-implementation to assess a change in the number of messages sent and received over 30-days. Results: After 14 weeks of implementation, huddle rates increased by 29.9% to 82.3% with a checklist completion rate of 85.6%. Teamwork scores decreased by 6.2%. The rate of secure text messages overall increased by 3.13%, but after more detailed analysis, the provider team with the best adherence to huddle and checklist usage experienced a 27.4% decrease in messages. Conclusions: Findings suggest that use of the checklist has improved the rate of huddles and help to decrease the frequency of text messages.