Quality CornerImproving communication in the ICU using daily goals☆,☆☆,★
Section snippets
Objectives
The specific aims of this article are to describe our efforts to evaluate the effectiveness of communication during daily rounds in the ICU and to improve communication through the use of a daily goals form.
Data sources and settings
This study was conducted as part of a collaborative effort between the Volunteer Hospital Association (VHA), the Institute for Healthcare Improvement (IHI), and an academic 16-bed surgical ICU to improve the quality of ICU care.
Study design
Patients in our ICU are cared for by an intensivist-led team that includes ICU attending physician and fellows, anesthesia and surgery residents, nurse practitioners, nurses, and a pharmacist. During each month there are 3 residents, who rotate monthly, and 3 nurse practitioners caring for patients in the ICU. During daily rounds, the ICU team visits each patient for about 20 to 25 minutes and develops a plan of care for the day, discussing evidence regarding diagnosis or therapy and developing
Data collection methods
The authors developed a survey to evaluate the extent to which team members understood the goals of therapy. To estimate the magnitude of the communication problem, the physician-researcher (P.P.) asked the ICU residents and nurses the following 2 questions after rounds: (1) How well do you understand the goals of care for this patient today? and (2) How well do you understand what work needs to be accomplished to get this patient to the next level of care? The response categories for each
Analysis and interpretation
The analysis is descriptive. We used a run chart to display LOS and the percent of residents and nurses who stated (scored 4 or 5) that they understood the daily goals and tasks for each patient before and after the intervention.
Results
During the first 2 weeks, less than 10% of residents and nurses understood the daily goals of therapy and the daily tasks to be completed. After implementing the goals form (Fig 1), the percent of residents and nurses who understood the daily goals increased to over 95%. Because the score for the question regarding goals and daily tasks were nearly identical, we present the goals data. The scores for residents and nurses were similar
Conclusion
At the start of the study, few residents or nurses understood the daily goals of care for patients in the ICU. After implementing the daily goals form, however, nearly all residents and nurses understood goals for the day and use of the form was associated with a 50% decrease in ICU LOS. This study did not evaluate how the use of the goals reduced LOS. Nevertheless, similar to personal effectiveness or project management tools, stating clearly the tasks, care plan, and communication plan to be
References (15)
- et al.
An alternative strategy for studying adverse events in medical care
Lancet
(1997) The new paradigm of crew resource management: Just what is needed to reengage the stalled collaborative movement? The Joint Commission
J Qual Improve
(2002)- et al.
Working together but apart: Barriers and routes to nurse-physician collaboration
J Qual Improve
(2002) Collaboration between nurses and physicians: No longer a choice
Acad Med
(1992)- et al.
She won't be dancing anyway: A study of surgeons, surgical nurses and elder patients
Qual Health Res
(1993) Nurses and doctors: A problem of partnership
The impact of physician-nurse interaction on patient care
Holistic Nurs
(1999)
Cited by (0)
- ☆
Supported in part by a grant (U18HS11902-02) from the Agency for Healthcare Research and Quality (P.P.); and a grant (K23HL70058-01) from the National Heart, Lung and Blood Institute (S.B.).
- ☆☆
Address reprint requests to Peter Pronovost, MD, PhD, Associate Professor, Departments of Anesthesiology & Critical Care Medicine, Surgery and Health Policy & Management, The Johns Hopkins University, 600 N. Wolfe St, Baltimore, MD 21287; e-mail: [email protected].
- ★
0883-9441/03/1802-0001$30.00/0