Cohorting Trauma Patients in a Medical/Surgical Unit at a Level I Pediatric Trauma Center to Enhance Interdisciplinary Collaboration and Documentation

Abstract

Medical errors are a significant issue in health care that may be avoided through enhanced communication and documentation. This study examines interdisciplinary communication and compliance with trauma standards of care demonstrated through following the implementation of cohorting trauma patients to one medical/surgical unit and instituting daily interdisciplinary trauma patient rounds. Potential benefits include enhanced communication, improved nursing satisfaction, and increased compliance with trauma standards of care demonstrated through documentation, which the literature suggests improves quality of care. Pre- and postcohorting surveys related to safety attitudes, comfort with caring for trauma patients, and the efficacy of cohorting were administered to the nursing staff. As a marker for increased compliance with trauma standards of care, medical records were reviewed for completion of substance abuse screening upon admission and Functional Independence Measure screening at discharge. The results were compared after the cohorting initiative with 2 years prior. The rate of compliance with substance abuse screening increased from an average of 62.5% in 2015 and 2016 to 84% in 2017. Functional Independence Measure compliance increased from an average of 72.5% in 2015 and 2016 to 94% in 2017 following the cohorting intervention. Nursing perceptions of teamwork, safety climate, and staff support significantly improved (p < .05) from pre- to postcohorting surveys. Improvements were noted in comfort with performing tasks associated with caring for trauma patients but were not statistically significant. Cohorting trauma patients to one medical/surgical unit resulted in positive perceptions of professional relationships, improved communication, and compliance with trauma standards of care for documentation.

Strategies to Improve Compliance with Clinical Nursing Documentation Guidelines in the Acute Hospital Setting: A Systematic Review and Analysis

“…It should be noted that the results for Elliott (2018) must be used with caution as some neg-ative results may have left out in the final calculation of compliance rates. Ten studies included administrative or system changes as one of the strategies to improve nursing documentation (Ammenwerth et al, 2001;Dehghan et al, 2015;Enright et al, 2015;Gerdtz et al, 2013;Kamath et al, 2011;Mansfield et al, 2001;Meyer et al, 2019;Okoyo Nyakiba et al, 2014;Stewart et al, 2009;Trad et al, 2019). All of the system changes improved nursing documentation, six of them had a final compliance rate ≥70% (Ammenwerth et al, 2001;Enright et al, 2015;Kamath et al, 2011;Mansfield et al, 2001;Meyer et al, 2019;Stewart et al, 2009).…”

Ventral hernia patient outcomes postoperatively housed on surgical vs non-surgical units

“…One trauma center found cohorting trauma patients to one unit with daily interdisciplinary rounds resulted in significantly ( p < 0.05) improved perceptions of teamwork, communication, and compliance with standards of care [ 17 ]. Familiarity with tasks associated with trauma patient care also increased, though it was not found to be statistically significant.…”

“…While no association between cost and patient location was found in our study despite LOS variation, prior findings have correlated prolonged LOS to net loss of revenue [ 2 , 14 ]. Moreover, transfer between units may increase non-surgical staff stress due to lack of experience with postoperative patients on medical units, such as seen in nursing staff caring for trauma patients prior to cohorting [ 17 ].…”

Transformation of observation unit to address higher acuity patients and increase bed capacity during a Covid-19 surge

“…Cohorting may lead to improved outcomes, including increased compliance with standards to prevent the spreading of contagious diseases, the monitoring of patients' status, and the perceptions of staff members as to increased care and patient safety. [2] Cohorting has been used to decrease length-of-stay and in-hospital transmission in influenza patients. [3] An Irish hospital practiced cohorting during the 2017/2018 influenza season.…”