Implementing Patient Triage Communication, Improving Nurse-Provider Communication and Promoting Safety
AdvisorSatyshur, Rosemarie D.
MetadataShow full item record
Other TitlesImplementation of a Communication Template
AbstractProblem & Purpose: Ineffective handoff communication is a critical patient safety problem resulting in delays in treatment and adverse events. At a large, hospital-based outpatient clinic of a large East Coast academic medical center, the lack of a standardized communication tool resulted in messages that were misunderstood or lacked valuable information. The purpose of this evidence-based quality improvement project was to facilitate nurse-provider communication through the implementation and evaluation of a patient triage communication tool based upon situation, background, assessment, recommendation (SBAR) methodology. Methods: This DNP project was guided by Lewin's Change Theory. A retrospective electronic health record (EHR) review demonstrated a lack of a structured communication method resulting in communication breakdowns. A literature review demonstrated that SBAR methodology creates a common language for nurse-provider communication. An adapted SBAR methodology communication tool was uploaded into the EMR. Over nine weeks, triage nurses and providers from trauma general surgery teams A, B, C, D, and ACES utilized the communication tool for every patient call. Weekly chart audits evaluated the median time at each point in communication and length of time to close the call encounter. Safety Attitude Questionnaire (SAQ) evaluated teamwork and safety climate pre-implementation and post-implementation. Results: Compliance with the standard communication tool ranged from 83% to 100% (average 95%). The reason for the lack of use in week one of implementation was electronic health record coding issues within the communication tool. Comparing data 1-month pre-implementation through 9 weeks of implementation: SAQ demonstrated the lack of teamwork remained steady at 60%, and communication breakdowns decreased from 70% to 40%; time cycling demonstrated: nurse to provider communication response mean decreased from 1.91 to 1, provider to nurse communication response mean decreased from 0.97 to 0.84 and nurse to patient communication response mean decreased from 1.05 to 0.86. The median length of time from the initial call to the encounter closure decreased from 245.5 (4.09 hours) to 155 (2.58 hours). Process cycling revealed that the triage process could not be standardized under the defined steps as it did not account for variability in nursing practice or quality of the voice messaging system. Conclusions: The standardization of triage documentation impacted the time from the initial call to encounter closure as well as the number of responses between nurses and providers. While the time benchmark of 120 minutes (2 hours) was not met, the improved response times have led to leadership support for sustainability and spread to the remaining four trauma specialty surgery teams.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/12936
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Healthcare Provider Communication with Young Adults: Patient-Centered Communication, Patient Satisfaction, Patient Trust, Social Support, Self-Care Skills, and Emotional Well-BeingNichols, Helen M.; Sacco, Paul; 0000-0002-6782-0869 (2018)Patient-centered communication is critical to the delivery of quality healthcare services. Although numerous health outcomes have been connected to patient-provider communication, there is limited research that has explored the processes and pathways between communication and health. Research among young adults (ages 26-39 years) is even more scarce, despite findings that health communication does vary with age. This study used data from the 2014 Health Interview National Trends Survey to (1) test a scale of seven items measuring patient-centered communication among young adults age 26 to 39 and (2) explore the relationship between patient-centered communication, patient trust, patient satisfaction, social support, self-care skills, and emotional well-being among young adults age 26 to 39. Exploratory and confirmatory factor analyses were conducted and results showed that a one-factor model of patient-centered communication among young adults fit the data well. In the final regression model, income, history of depression diagnosis, patient-centered communication, patient trust, social support, and patient self-efficacy (self-care skills) were all significantly related to emotional well-being. Post-hoc analyses showed that self-efficacy and patient trust modify the association between general health and emotional well-being. Among respondents who reported poor overall health, increases in self-efficacy and trust in their provider are associated with corresponding improvement in their predicted emotional well-being. This is in contrast to respondents who reported excellent overall health, for whom an improvements in self-efficacy and trust did not have the same effect on predicted emotional well-being. There was a significant interaction between depression and self-efficacy, as respondents who reported being diagnosed with depression showed a stronger relationship between self-efficacy and greater predicted well-being. Post-hoc analyses also showed significant interactions between patient-centered communication, satisfaction, and social support. Respondents who reported lower levels of PCC, showed decreased predicted emotional well-being as their satisfaction and perceived social support increased. These findings suggest the need to explore the means through which communication can impact emotional well-being, specifically among young adults who are in poor health or have a history of depression. Future research should also include longitudinal studies, in order to determine causality and directionality among constructs.
Improving Staff Communication and Teamwork As a Psychiatric Day ProgramAitken, Molly K.; Michael, Kathleen (2019-05)Background: The Institute for Healthcare Improvement has identified four foundational principals for making health care systems and processes safer and more reliable: Standardized processes and care, Simplified processes, Reduced autonomy, and Highlighting deviations from practice. They recommend use of the TeamSTEPPS Situation, Background, Assessment, Recommendation/Request (SBAR) technique to maximize communication between members of healthcare teams. TeamSTEPPS is a training program that was developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD), with the most recent version being TeamSTEPPS 2.0. It consists of five key principals: Team Structure, Communication, Leadership, Situation Monitoring, and Mutual Support. Local Problem: A behavioral health provider in Baltimore City recognized the need to improve teamwork, communication, and efficiency during shift-change report among staff members at their psychiatric day program. Interventions: Fall of 2017, training was done with staff members at this psychiatric day program on TeamSTEPPS 2.0’s key principals of Communication and Leadership. October 3, 2018, training was done on the key principal of Situation Monitoring, implementation of the mnemonic “I PASS THE BATON” – the new evidence based standard for handoffs, and refresher training on Communication and Leadership. Participants completed the Teamwork Attitudes Questionnaire (T-TAQ) prior to training and again after a seven-week implementation period. Results: Eleven staff members (n=11) were trained on October 3, 2018. Comparison of the pretraining and post-training T-TAQ questionnaires yielded evidence of improved staff attitudes toward team structure (38%), leadership (9%), situation monitoring (23%), and communication (38%), as evidenced by a greater number of Strongly Agree responses on the post-training questionnaires. Although there was a 14% improvement in the number of Strongly Agree responses for the category of mutual support, the overall percentage of Strongly Agree responses remained fairly low at only 33%. This agency continues to encourage its staff members to utilize the “I PASS THE BATON” mnemonic during shift reports. Conclusions: TeamSTEPPS 2.0 is a good fit for improving teamwork, communication, and efficiency of shift-change reports for this psychiatric day program. Continued training and refresher training, as well as inclusion of this training as competencies for new-hires, will be essential for maintaining these skills and improving patient outcomes.