Improving Nurse-Nurse Communication to Reduce Patient Bounce-Back

Abstract

Problem & Purpose: A deficit in nurse communication was identified, causing 2-5% of patients bounced-back (readmitted) to the emergency department (ED) from the psychiatric emergency services (PES). No report tool was currently used. This suboptimal communication contributed to a lack of rapport, poor workflow, and reduced patient safety, making implementation of a communication tool for the receiving nurse in PES essential. The purpose of this project was to implement and evaluate a psychiatric SBAR tool (PSYCH) utilized by PES nurses when receiving report on patients from the ED. The goal was to reduce the current rate of 2-5% patient bounce-back in PES to 0% through improvements in nurse communication. Methods: The theoretical framework used was Kurt Lewin’s Change Theory, guided by the MAP-IT model. Subjects included were all PES nurses. Data was collected using the AHRQ TeamSTEPPS T-TAQ Communication Scale, Random Observations, and Patient Bounce-Back Audit Form. The T-TAQ communication scale was identified to collect data on nurse perception of communication between PES and the ED, analyzed by Independent samples t-tests. Results: Pre-T-TAQs found the ED perception of communication (M = 24.25) was hypothesized to be lower than PES’s perception (M = 25.75). This difference was found to be significant, t(30) = -1.85, p = 0.04. Post- T-TAQ scores were not found to be significant. Patient bounce-back reduced to 0.8% throughout implementation. Conclusion: This project showed the feasibility of a PSYCH tool used during report between two emergency units to improve communication. It allowed nurses to comprehend information gathered, enhancing efficiency by reducing redundancy. The project reduced patient bounceback and identified security concerns impacting patient and staff safety. The results reinforced the importance of gathering all pertinent data using a standardized tool for furthering effective communication.