Better Together: Provider, nurse and patient partnerships improve care
Increased patient safety, decreased patient and family anxiety, greater patient satisfaction, enhanced teamwork, improved relationships among care teams and higher job satisfaction. Is it true that so many benefits could result from one thing? Yes!
Effective communication between nurses, providers, patients and their families creates a positive partnership that benefits everyone. That’s why two teams at University Hospital and the Frankel Cardiovascular Center (UH/CVC) are determined to overcome hurdles and develop strategies that encourage and support regular, ongoing communication among care teams, and between health care providers and their patients.
“The goal is for everyone on the care team to be on the same page,” said Staci Blackburn, M.D., who is the medical director on 8B and part of an interdisciplinary team working to promote shared rounding where nurses and providers see patients together on a daily basis.
“We know effective communication can lead to fewer adverse effects and improve patient outcomes,” she said.
Everyone on the same page
The authors of an article published in the International Journal of Nursing Sciences noted that The Joint Commission cites communication failure as the cause of two-thirds of sentinel events in health care. The authors went on to discuss research showing that dysfunctional communication accounted for 91 percent of the medical errors reported by resident physicians.
“When the provider and nurse can meet together in the patient’s room, everyone is aware of the care plan,” said Blackburn. “This communication is an important component of highly-reliable patient care.”
A second team in the adult hospitals is focused on ensuring that bedside shift reports, where the outgoing and oncoming nurses meet together with patients to review their condition and plan of care, occur at every shift change.
Pete Bryant, B.S.N., R.N., staff specialist who works in the office of UH/CVC’s chief nursing officer, together with Lamia Marouf, B.B.A., M.A., senior project manager for inpatient hospital operations, and six nursing leadership teams across UH/CVC make up a nursing communication workgroup that is developing a framework, tools and education for a standardized approach to bedside shift report that will soon be rolled out across the adult hospitals.
“A growing body of evidence suggests that engaging patients and families and keeping them informed of the plan improves safety and quality of care,” said Bryant. “When patients know what to expect as they are moved from one unit to another during their stay, and they experience consistency in communication, they feel more involved and confident in the care they are receiving.”
“Standardizing the process will help eliminate the potential for confusion and errors,” said Marouf. “We are working hard to create an environment where the expectation for bedside shift report is the same across all nursing units. Fostering a culture of safety and increased accountability among nurses that is driven by nurses themselves is a recipe for sustained safety and quality of care for our patients.”
Working toward goals
Right now, it is estimated that bedside shift reports occur 60-65 percent of the time. The goal for the future is 100 percent compliance.
“We hear questions from nurses about how to perform bedside shift report when patients are sleeping, how to work around the lack of writing surfaces in the rooms, handling sensitive patient information and concerns about getting off work late if reports are given,” said Bryant. “Our framework and toolkit address these questions, with instructions for performing safety checks, using an SBAR (situation, background, assessment, recommendation) tool to keep the dialogue focused and setting time limits for each patient report.”
“The materials we’ve developed will ensure that all units have what they need to educate and empower staff to engage in effective communication with each other and with patients,” Marouf added.
The shared rounding team reports that on the medicine units at the hospital, providers and nurses currently round together only 20 percent of the time. The team is still developing process measures with local units to support the success of the project. They will look at things like how often teams are rounding together and the impact of increased communication on patient satisfaction scores.
In addition to crucial benefits like increased safety and satisfaction, bedside reports and shared rounding are sure to enhance teamwork and create stronger relationships among care teams.
While the benefits are plentiful, challenges also exist for shared rounding, including the timing of rounds, competing patient care needs, limited communication devices and methods, patient location and unit design.
“Another challenge for us is that shared rounding is not yet part of the culture here,” said Jeff Rohde, M.D., medical director on 7A. “We’re working on it, just like we’re working on other key skills and behaviors that will lead to high reliability.”
The shared rounding project brings together nurses and providers from five different units who are helping to identify what works well and what doesn’t. The team is continually looking for ways to support direct communication between nurses and providers.
“We know culture change takes time,” said Rohde. “We’ve started emphasizing the importance of shared rounding with our nursing leadership and faculty teams, and with our colleagues on the units. We are confident that, through the work we are doing as a team, we can make and sustain important changes that will begin to transform the culture.”
“Our ultimate goal is to round together daily to provide the highest quality, safest and most reliable care,” said Blackburn.
Bryant and Marouf share a similar sentiment for bedside shift report.
“Our goal is for bedside report to happen with every patient at every shift change,” said Bryant. “When we work together, taking the time to communicate clearly with each other and with patients and their families, we are able to provide better, safer care.”