School of Medicine and Health Sciences Poster Presentations

Title

Optimizing Nurse-Physician Communication During Morning Rounds

Poster Number

320

Document Type

Poster

Status

Medical Student

Abstract Category

Quality Improvement

Keywords

Quality improvement, communication, interdisciplinary rounds, structured communication protocols, provider satisfaction

Publication Date

Spring 2018

Abstract

Introduction:

The Joint Commission found that communication problems were the third most frequent root cause of reported sentinel events in 2015. Research on interdisciplinary rounds and protocols to improve communication has been limited. Structured communication tools have been shown to enhance collaboration between nurses and physicians. This study aims to analyze the impact of a combination of Trio Rounding - a collaborative rounding approach between nurses, physicians, and patients – and a structured communication protocol on interdisciplinary communication.

Methods:

To elicit existing gaps in communication, a free-text questionnaire was randomly administered to nurses and physicians in the Department of Medicine at George Washington University Hospital, a tertiary care center in the District of Columbia. Results were used to outline the satisfaction surveys and the structured communication protocol, which highlights plan for the day, preventative measures and placement plans (the “3 Ps”).

Nurses and physician assistants (PAs) in the Department of Medicine enrolled in this before-and-after study. Trio Rounding and the structured communication protocol were implemented for 5 weeks. To assess satisfaction with communication, 5-point Likert Scale surveys were administered pre- and post-intervention to nurses and PAs, with a score of 5 indicating complete satisfaction and a score of 1 indicating complete dissatisfaction.

Results:

8 nurses and 9 PAs completed the pre- and post- intervention surveys. For nurses, although paired T-tests revealed slightly increased satisfaction with combined communication aspects (plan of care, safety measures, discharge planning, and nurse-physician relationships) from pre- to post- intervention, these results were not statistically significant (11.88 vs. 12.13, p=0.8489). For PAs, paired T-tests revealed increased satisfaction with nurse-physician relationships from pre- to post-intervention (1.89 vs. 3.33, p=0.0117) and increased satisfaction with combined communication aspects from pre- to post-intervention (10.00 vs. 14.89, p=0.0254). Consistently pre- and post-intervention, majority of nurses and PAs believed that overlap of nursing duties was the greatest barrier to communication during rounds.

Conclusions:

Based on these results, our intervention had a significant impact on PA satisfaction with interdisciplinary communication. Limitations included the short duration of intervention and small sample size. Our study highlights that implementation of Trio Rounding in conjunction with a structured communication protocol improves satisfaction with interdisciplinary communication, and thus has the potential to mitigate communication problems that commonly lead to medical errors.

Keywords:

Quality improvement, communication, interdisciplinary rounds, structured communication protocols, provider satisfaction

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Optimizing Nurse-Physician Communication During Morning Rounds

Introduction:

The Joint Commission found that communication problems were the third most frequent root cause of reported sentinel events in 2015. Research on interdisciplinary rounds and protocols to improve communication has been limited. Structured communication tools have been shown to enhance collaboration between nurses and physicians. This study aims to analyze the impact of a combination of Trio Rounding - a collaborative rounding approach between nurses, physicians, and patients – and a structured communication protocol on interdisciplinary communication.

Methods:

To elicit existing gaps in communication, a free-text questionnaire was randomly administered to nurses and physicians in the Department of Medicine at George Washington University Hospital, a tertiary care center in the District of Columbia. Results were used to outline the satisfaction surveys and the structured communication protocol, which highlights plan for the day, preventative measures and placement plans (the “3 Ps”).

Nurses and physician assistants (PAs) in the Department of Medicine enrolled in this before-and-after study. Trio Rounding and the structured communication protocol were implemented for 5 weeks. To assess satisfaction with communication, 5-point Likert Scale surveys were administered pre- and post-intervention to nurses and PAs, with a score of 5 indicating complete satisfaction and a score of 1 indicating complete dissatisfaction.

Results:

8 nurses and 9 PAs completed the pre- and post- intervention surveys. For nurses, although paired T-tests revealed slightly increased satisfaction with combined communication aspects (plan of care, safety measures, discharge planning, and nurse-physician relationships) from pre- to post- intervention, these results were not statistically significant (11.88 vs. 12.13, p=0.8489). For PAs, paired T-tests revealed increased satisfaction with nurse-physician relationships from pre- to post-intervention (1.89 vs. 3.33, p=0.0117) and increased satisfaction with combined communication aspects from pre- to post-intervention (10.00 vs. 14.89, p=0.0254). Consistently pre- and post-intervention, majority of nurses and PAs believed that overlap of nursing duties was the greatest barrier to communication during rounds.

Conclusions:

Based on these results, our intervention had a significant impact on PA satisfaction with interdisciplinary communication. Limitations included the short duration of intervention and small sample size. Our study highlights that implementation of Trio Rounding in conjunction with a structured communication protocol improves satisfaction with interdisciplinary communication, and thus has the potential to mitigate communication problems that commonly lead to medical errors.

Keywords:

Quality improvement, communication, interdisciplinary rounds, structured communication protocols, provider satisfaction