[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The Joint Commission International Patient Safety Goal 2 states that effective communication between health care workers needs to improve. The aim of this study was to determine the effect of SBAR (= Situation, Background, Assessment, Recommendation) on the incidence of Serious Adverse Events (SAE's) in hospital wards. METHOD: In 16 hospital wards nurses were trained to use SBAR to communicate with physicians in cases of deteriorating patients. A pre (July 2010 and April 2011) and post (June 2011 and March 2012) intervention study was performed. Patient records were checked for SBAR items up to 48hours before a SAE. A questionnaire was used to measure nurse-physician communication and collaboration. RESULTS: During 37,239 admissions 207 SAE's occurred and were checked for SBAR items, 425 nurses were questioned. Post intervention all four SBAR elements were notated more frequently in patient records in case of a SAE (from 4% to 35%; p<.001), total score on the questionnaire increased in nurses (from 58 (range 31-97) to 64 (range 25-97); p<.001), the number of unplanned Intensive Care Unit (ICU) admissions increased (from 13.1/1000 to 14.8/1000 admissions; Relative Risk Ratio (RRR)=50%; 95% C.I. 30-64; p=.001) and unexpected deaths decreased (from .99/1000 to .34/1000 admissions; RRR=-227%; 95% C.I. -793- -20; NNT 1656; p<.001). There was no difference in the number of Cardiac Arrest Team calls. CONCLUSION: After introducing SBAR we found increased perception of effective communication and collaboration in nurses, an increase in unplanned ICU admissions and a decrease in unexpected deaths.
[Show abstract][Hide abstract] ABSTRACT: Nurses and doctors undertake segregated and distinct preparation for clinical practice, yet are expected to communicate effectively with each other in the workplace. Most healthcare facilities have policies relating to written communication, but guidelines for verbal communication, which is used most in times of uncertainty and urgency, are generally less regulated. Poor communication and communication overload are shown to have a direct correlation with patient outcomes, adverse events and stressors among healthcare professionals. We suggest a guide for more effective verbal communication between nurses and doctors.
We perform an integrated review of the extensive literature that identifies specific problems that contribute to ineffective communication between a doctor and nurse. We discuss these in five themes in the modern clinical context including intensification of workload, workforce mobility, differing perceptions, language use and heuristics. To combat these, we provide a four point practical guide to arm the nurse clinician with effective tools to ensure a satisfactory exchange of information in the context of patient advocacy.
The guide assists in overcoming the discussed barriers by creating a premise for fostering communication, understanding each clinician's information needs in a mutually respectful manner, especially in the context of uncertainty. We recommend that a shared mental model regarding communication in health be adopted at tertiary institutions offering pre-registration nursing and medical training and techniques and be woven into respective curriculum design.
International Nursing Review 03/2011; 58(1):13-20. · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For hospitalized patients, handoffs between providers affect continuity of care and increase the risk of medical errors. Most commercial electronic health record (EHR) systems lack dedicated tools to support patient handoff activities. We developed a collaborative application supporting patient handoff that is fully integrated with our commercial EHR. The application creates user-customizable printed reports with automatic inclusion of a variety of EHR data, including: allergies, medications, 24-hour vital signs, recent common laboratory test results, isolation requirements, and code status. It has achieved widespread voluntary use at our institution (6,100 monthly users; 700 daily reports generated), and we have distributed the application to several other institutions using the same EHR. Though originally designed for resident physicians, today about 50% of the application users are nurses, 40% are physicians/physician assistants/nurse practitioners, and 10% are pharmacists, social workers, and other allied health providers.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.