Interdisciplinary Rounds and Structured Communication Reduce Re-Admissions and Improve Some Patient Outcomes

Abstract

Hospital communication is more than access to information. Among staff, it is about achieving situation awareness-an understanding of a patient's current condition and likely trajectory. In the multidisciplinary context of providing care, structure, consistency, and repeatability of communication will enable a shared understanding of the patient and plan, leading to improved patient satisfaction and outcomes. This was tested using the Situation-Background-Assessment-Recommendation (SBAR) protocol, a re-admissions risk assessment and daily interdisciplinary rounds (IDR) in the medical/surgical units of a hospital. The impact of these interventions on patient satisfaction, Foley catheter removal compliance, and patient re-admission rates was assessed. Over the 3 year period, Foley compliance improved from 78% to 94%, and re-admissions decreased from 14.5% to 2.1%, both significant. Patient satisfaction trended positively, but was not significant. These results support the value of SBAR and IDR, and are advocated to improve situation awareness and maintain focus on key patient data.

Situation, Background, Assessment, Recommendation (SBAR) Communication Tool for Handoff in Health Care – A Narrative Review

“…This study showed significant improvement in Foley catheter removal, reduction in re-admissions rate, and improvement in patient satisfaction. This study's results support the value of using SBAR during IDR to improve situational awareness and to maintain focus on relevant clinical issues (Table 1) [23].…”

“…Despite huge investments in technology to record, store, disseminate, and access information, studies still find communication in health care continues to be problematic [23]. Health care providers need to be cognizant of the challenges facing handoffs, including physical setting, social setting, language barriers, and communication barriers [24].…”

“…Townsend-Gervis M et al [23] 2014 USA Prospective study 111 nurses participated from 3 medical and surgical unit of Baptist Memorial Health Care Corporation .Nurses used SBAR in a variety of circumstances, including shift reports and physician rounds (both paper and electronic copy of SBAR was available for patient presentation)…”

Hospital Performance on Percutaneous Coronary Intervention Process and Outcomes Measures

“…For example, previous studies have shown that improvements in hospital systems such as organizational culture, including interdisciplinary rounding during hospitalization and at discharge, and optimization of patient care transitions were associated with improved 30‐day outcomes 29, 30, 31. Similarly, other qualitative studies have shown that high‐performing hospitals have specific organizational strategies and enabling structures that distinguish them, including: active communication and coordination among care givers; senior management‐level engagement and support; and an organizational commitment to developing and maintaining a focus on delivering high‐quality care 32, 33.…”

Identifying the nontechnical skills required of nurses in general surgical wards

“…The focus of publications pertaining to communication skills included verbal and nonverbal communication (Frankel et al, 2012), communicating with doctors (Donohue & Endacott, 2010), nursing handover (Cornell & Gervis, 2013;Cornell, Gervis, Yates, & Vardaman, 2014;De Meester, Verspuy, Monsieurs, & Van Bogaert, 2013;Radtke, 2013;Townsend-Gervis, Cornell, & Vardaman, 2014), the impact of different models of care on communication (Fernandez, Tran, Johnson, & Jones, 2010), communication technologies (Guarascio-Howard, 2011) and factors that impair communication (Johnson et al, 2014). The focus of publications pertaining to communication skills included verbal and nonverbal communication (Frankel et al, 2012), communicating with doctors (Donohue & Endacott, 2010), nursing handover (Cornell & Gervis, 2013;Cornell, Gervis, Yates, & Vardaman, 2014;De Meester, Verspuy, Monsieurs, & Van Bogaert, 2013;Radtke, 2013;Townsend-Gervis, Cornell, & Vardaman, 2014), the impact of different models of care on communication (Fernandez, Tran, Johnson, & Jones, 2010), communication technologies (Guarascio-Howard, 2011) and factors that impair communication (Johnson et al, 2014).…”