Improving Communication at the Point of Care: Best Practices

April 1, 2021
April 1, 2021

This blog post is based on a recent Webinar with Teresa Trammell, PNP, MHA, MSN, CCRN, Medical Field Representative, EBSCO Health

In 2009, researchers from the University of Maryland, Robert H. Smith, school of business, put a price tag on the cost of poor communication in US hospitals at $12 billion a year.

What is the Role of Communication in Improving Patient Safety and Outcomes?

A review of the literature reveals that better caregiver-to-patient communication will improve patient safety, care quality, and patient satisfaction, as well as increase workplace satisfaction, accountability, and retention. It can also support financial goals through decrease in length of stay, reduced overtime by making the transition of caregivers more efficient, and decreased liability by communicating with patients and ensuring their understanding of their care plan.

Bedside Shifts Recordings

As the industry transitions to a value-based care versus volume-based care systems, healthcare organizations are striving to develop programs and solutions to find success in this new environment. The first solution is bedside shifts recordings, which impact HCAHPS scores. Transforming care at the bedside allows for immediate patient identifications and an initial assessment, which we all know is key to preventing time-sensitive errors. Bedside shifts recording improves accuracy and allows for patient-centered care, and repeated information supports patients’ retention and understanding. It also gives time to address questions or for nurses to note a follow up if a discussion is wanted.

Standardized Communication Methods

A second solution is adopting proven communication methods. I recently was told by a nurse leader that the information is only as good as the person delivering it. We need to ensure we educate everyone on how to give the right information in an effective way. Staff needs to communicate clearly and avoid distractions during shift transitions. An example of successful standardization of reporting is SBART, which is situation, background, assessment, recommendations, and thanks. A second is I-PASS; the Boston Children's Hospital’s adoption of it resulted in a 30% reduction in preventable mistakes. A further study by the Millennium Journal of Medicine involved nine other pediatric hospitals that implemented I-PASS; they had a 23% drop in preventable mistakes at each of their institutions.

Checklists for Handoffs

Lastly, checklists should be used as the handoff assessment tool to aid staff, especially with heavy patient assignments to focus on important information in a systematic manner. Customization for the unit is important for success.

Focus on a Team Approach

Encourage the team approach to communication and ask each member, “What does good customer service look like?” Because communication will be at the heart of quality patient care. These can be done with regular team huddles or by designated individuals with unit oversight. For this to be successful coordination must occur with physicians, nurses, and allied health specialties. We should integrate families into all aspects of daily decision-making and communication. Many healthcare systems have had great success with patient and family advisory councils. These groups can have an impact on the overall effectiveness of healthcare organizations by improving HCAHPS scores, reputation, quality, and safety.

Address Patient Expectations Constantly

Communication is important when it comes to patient expectations; Emory University saw HCAHPS scores rise to 98% (where the national average is 80%) by focusing solutions on patient-centered care. Stating patients' expectation at registration time is a good time to start. Patients should be informed and asked what to do if they were sleeping during report time or had family or visitors present. We should re-visit the process throughout hospitalization and when transferred from unit to unit. We should give the patient notification approximately one hour prior to report. This can be done by a nurse's aide or even a volunteer. We should explain, check the needs of the patient so that when report time comes they're not surprised or have a last minute need. Lastly by encouraging patients and family participation and setting the expectations we can empower our patients in their recovery. Ask yourself, "Who is your patient advocate at your institution or on your unit?"

Don’t Forget Culture

Finally, the last communication solution is around the culture. We need to dismantle the hierarchy mentality and ensure that each person has value and a voice within our institutions. We must build relationships between each other and our patients. Transparency is vital, but if we don't talk about errors or near errors we'll be doomed to repeat them. The top down mentality must be present to support our staff and work-life balance will also translate in the quality care with happier staff and happier patients.

In summary, a systematic review of the literature has clearly defined evidence-based methods in transforming outcomes through improved and consistent caregiver to patient communication. What about challenges and strategies? Managing change can be difficult. First you have to ensure front line engagement. You need to hire nurses for resiliency and communication abilities. Know your millennial strengths and weaknesses to retain them. Involve your bedside nurse in creating solutions and reward them for participating. Empowerment. Studies have shown that nurse coaches or mentors present beyond new-hire periods improve stress levels and communication skills. Accountability between the health care providers and with our patients will help improve communication and patient outcomes.

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