Brian T Wessman1,2, Carrie Sona3, Marilyn Schallom4. 1. 1 Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. 2. 2 Division of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. 3. 3 Department of Nursing, Barnes-Jewish Hospital, St. Louis, MO, USA. 4. 4 Department of Research for Patient Care Services, Barnes-Jewish Hospital, St. Louis, MO, USA.
Abstract
BACKGROUND: Poor communication among health-care providers is cited as the most common cause of sentinel events involving patients. Patient care in the critical care setting is incredibly complex. A consistent care plan is necessary between day/night shift teams and among bedside intensive care unit (ICU) nurses, consultants, and physicians. Our goal was to create a novel, easily accessible communication device to improve ICU patient care. METHODS: This communication improvement project was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 214 admissions per month. We created a glass door template embossed on the glass that included 3 columns for daily goals to be written: "day team," "night team," and "surgery/consultant team." Assigned areas for tracking "lines," "antibiotics," "ventilator weaning," and "Deep vein thrombosis (DVT) screening" were included. These doors are filled out/updated throughout the day by all of the ICU providers. All services can review current plans/active issues while evaluating the patient at the bedside. Patient-identifying data are not included. We retrospectively reviewed all ICU safety reported events over a 4-year period (2 years prior/2 years after glass door implementation) for specific handover communication-related errors and compared the 2 cohorts. RESULTS: Information on the glass doors is entered daily on rounds by all services. Prior to implementation, 7.96% of reported errors were related to patient handover communication errors. The post glass-door era had 4.26% of reported errors related to patient handover communication errors with a relative risk reduction of 46.5%. Due to its usefulness, this method of communication was quickly adopted by the other critical care services (cardiothoracic, medical, neurology/neurosurgery, cardiology) at our institution and is now used for over 150 ICU beds. CONCLUSIONS: Our glass door patient handover tool is an easily adaptable intervention that has improved communication leading to an overall decrease in the number of handover communication errors.
BACKGROUND: Poor communication among health-care providers is cited as the most common cause of sentinel events involving patients. Patient care in the critical care setting is incredibly complex. A consistent care plan is necessary between day/night shift teams and among bedside intensive care unit (ICU) nurses, consultants, and physicians. Our goal was to create a novel, easily accessible communication device to improve ICU patient care. METHODS: This communication improvement project was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 214 admissions per month. We created a glass door template embossed on the glass that included 3 columns for daily goals to be written: "day team," "night team," and "surgery/consultant team." Assigned areas for tracking "lines," "antibiotics," "ventilator weaning," and "Deep vein thrombosis (DVT) screening" were included. These doors are filled out/updated throughout the day by all of the ICU providers. All services can review current plans/active issues while evaluating the patient at the bedside. Patient-identifying data are not included. We retrospectively reviewed all ICU safety reported events over a 4-year period (2 years prior/2 years after glass door implementation) for specific handover communication-related errors and compared the 2 cohorts. RESULTS: Information on the glass doors is entered daily on rounds by all services. Prior to implementation, 7.96% of reported errors were related to patienthandover communication errors. The post glass-door era had 4.26% of reported errors related to patienthandover communication errors with a relative risk reduction of 46.5%. Due to its usefulness, this method of communication was quickly adopted by the other critical care services (cardiothoracic, medical, neurology/neurosurgery, cardiology) at our institution and is now used for over 150 ICU beds. CONCLUSIONS: Our glass door patient handover tool is an easily adaptable intervention that has improved communication leading to an overall decrease in the number of handover communication errors.
Authors: Samara Zavalkoff; Maud Mazaniello-Chezol; Shauna O'Donnell; Kadine Cunningham; Mohammed Almazyad; Ashley O'Reilly; Kimberley Macedo; Kimberly Lammeree; Ellen Mitchell; Chrysanthi Roussianos; Marie Antonacchi; Gabrielle Cunnigham; Matthew Park; Ronald Gottesman Journal: BMJ Open Qual Date: 2021-09