Download Charter Form - Institute for Healthcare Improvement

Improving Communication Compliance between Patient Caregivers to Increase Patient
Satisfaction, Patient Outcomes and Quality of Care, in Addition to Provider Satisfaction
and to Decrease Hospital Costs
Christina A. Galgano, RN
Health System Sponsor: John Finnerty, RN - Nassau University Medical Center, E. Meadow NY
Farmingdale State University of New York
Charter Form
What are we trying to accomplish?
Aim Statement
We aim to improve the compliance rate of nurse and physician and nurse to nurse
communication to 90% or higher for each trauma patient in the Surgical ICU at NUMC in East
Meadow, New York, by May 1, 2014.
Problem to be Addressed
This study will improve the rate of communication between Nurse to Nurse, and Physician to
Nurse and vice versa in the Surgical ICU. It will improve patient satisfaction, patient safety,
patient outcomes, and quality of care by ensuring the system runs more smoothly. All caregivers
involved, as well as the patients and their families/healthcare proxies will be well informed and
educated on the plan of care, thus allowing everyone to be involved in the communicative efforts
of the arrangement and development of a patient specific plan of care. In addition, the caregiver
rate of job satisfaction will be positively affected as communication is enhanced, along with a
decrease in institutional financial costs.
Reason for the Effort
Every facility can benefit from increased communicative efforts as, “Communication failure has
been identified as the leading root cause of sentinel events by the Joint Commission (Friesen et
al., 2007).” This results in negatively affected:

Patient Satisfaction: Patients are often unsure of the plan of care and have a lack knowledge
and understanding of their condition. They are frequently misinformed by multiple personnel
being told different plans, ultimately leading to higher stress levels and decreased levels of
satisfaction and trust in the facility and its providers. Provider communication and patient
education are both extremely important to levels of patient satisfaction. “Patients’
participation in health care assessments has been largely associated with better health
outcomes (Dreeben-Irimia, 2010, p. 4).” Patient awareness and education:
1. Attracts patients to the provider and increases patients’ satisfaction with their care,
and ultimately decreases the provider’s risk of liability
2. Promotes patient-centered care which results in patients’ active involvement in
their plan of care
3. Increases adherence to medication and treatment regimens, leading to a more
efficient and cost-effective health care delivery system
4. Ensures continuity of care and reduces the complications related to illness and
incidence of disorder/disease (Dreeben-Irimia , 2010, p. 8)

Patient Safety, Outcomes and Quality of Care: Evidence shows that as communication is
enhanced patient outcomes such as length of stay (LOS), and rate of hospital acquired
infections (i.e.: central line infection and ventilator-associated pneumonia) are decreased
(Pronovost et al., 2003, p. 73). Lower mortality and lower readmission rates are noted as a
positive patient outcome resulting from effective communication among health care
professionals (Dingley et al., 2008, p. 2). “Ineffective communication among health care
team members contributes to patient harm and adverse events, interventions and
implementation methods become instrumental in preventing negative patient outcomes
(Dingley et al., 2008, p. 16).”

Provider Satisfaction: It can be frustrating and stressful for healthcare providers to work
with others that are not communicating the patient plan of care, whether from their own or
from other disciplines. A pre and post-test study measuring communication variables and
provider stress levels performed by DK Boyle in 2004 found “significant improvements in
communication skills and leadership skills and leadership characteristics exhibited;
significant improvement in professional satisfaction in relationship to personal stress and
situational stress (Hughes, 2008, p. 570).” Provider job satisfaction is directly related to
patient satisfaction. A public release of data from the Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS) survey examined the relationship between
nursing and patient satisfaction across 430 hospitals and found that “the nurse work
environment was significantly related to all HCAHPS patient satisfaction measures (KutneyLee et al., 2009, p. 669).”

Hospital Costs: Not only does poor communication negatively affect patient care and
provider job satisfaction, but it also affects hospital financial costs. “Hospitals now have a
financial incentive to improve their quality of care to increase patient satisfaction (KutneyLee et al., 2009, p. 670).” Multiple studies noted by the Agency for Healthcare Research and
Quality indicate a significant decrease in hospital costs resulting from increased caregiver
collaboration. These studies are displayed in the Patient Safety and Quality: An Evidence
Based Handbook for Nurses in a table titled the Cochrane Collaborative Results:
Randomized Controlled Trial Focused on Increasing Collaboration between Nurses and
Physicians Evidence, Table No. 2 (Hughes, 2008, p. 565-569). As per a pre- and postquasi-experimental study done in 2001 by Henneman, in which there was a control group and
intervention group in an ICU setting aimed towards interventions of increased nurse
physician collaboration; it was found that multidisciplinary rounds every morning, and the
availability of assessment and progress data in medical record, resulted in a “significant decrease
in length of time on ventilator; significant decrease in LOS; some decrease in hospital hosts; and
mixed results for readmission rates (Hughes, 2008, p. 569). This will prove effective in
significant financial impact on NUMC institutional costs, especially with the rapid drastic
changes seen with insurance and Medicaid reimbursement plans.
Expected Outcomes/Benefits
In conjunction with TeamSTEPPS, a NuHealth identified 2013/14 performance improvement
priority we plan to implement an electronic updatable plan of care that will be updated after the
TeamSTEPPS huddle takes place. This plan of care will meet the current TJC/CMS standards
and will initially be used solely by the nursing staff, and will become a part of the report in
which both nurses will sign off on. Hopefully moving forward we can add other sections for the
other various disciplines that participate in the patients’ plan of care. However, at the current
time, the program will be accessible for viewing by all disciplines involved. It will be a
reference guide to the staff in regards to what the current determined plan of action unique to the
patients needs to facilitate in identifying a clear, concise, and accessible format. This will help
with the unity of the care team and communication efforts between the patient and all of their
involved
providers leaving less room for misunderstandings or misinforming.
How do we know that change is an improvement?
Our aim is to improve provider and patient communication by developing an updatable plan of
care to be used as a reference guide in the plan of action. Various risks, patient strengths and
weaknesses will be identified, which will be a reminder of needed interventions. There is much
supporting scholarly evidence indicating the benefits of increased communication between care
providers, therefore, our outcome will be measured by nurse compliance rates. Our balancing
measures include patient and staff satisfaction after the changes are initiated. Being that this
study is of limited time, hopefully the electronic care plan will become a part of the medical
record and standard practice. If this implementation should continue to be utilized the QI
department will be able to retrieve more hard data such as decreased rates of central line
infection, decreased length of hospital stay, decreased ventilator associated pneumonia,
decreased falls, improved Press Ganey score, improved HCAHPS surveys, and decreased
hospital costs.
What changes can we make that will lead to improvement?
Once the electronic care plan is completed, it will be implemented for use in the SICU, and will
be used in conjunction with the already standard nursing report to ensure clarity of the patients’
plan of care for that day. It will be updatable by the nursing staff, and accessible by all involved
disciplines for viewing. The form will be updated according to the information presented at the
unit Physician and Nurse TeamSTEPPS huddle at the beginning of every shift. The form also
will be updated as any changes in the patients’ condition should occur. This will offer an avenue
for all providers to access to view the established plan of care so that there are no
miscommunications.
References
Dingley, C., Daugherty, K., Derieg, M. K., & Persing, R. (2008). Improving patient safety
through provider communication strategy enhancements. Retrieved from
http://www.ahrq.gov/downloads/pub/advances2/vol3/advances-dingley_14.pdf
Dreeben-Irimia, O. (2010). Patient education in rehabilitation. Sudbury, Mass: Jones and
Bartlett Publishers.
Friesen, M. A., Hughes, R., & Zorn, M. (2007). Communication: Patient safety and the nursing
work environment. Nursing that Works, 13,
Hughes RG (ed.). Patient safety and quality: An evidence-based handbook for nurses. (Prepared
with support from the Robert Wood Johnson Foundation). AHRQ Publication No. 08-0043.
Rockville, MD: Agency for Healthcare Research and Quality; March 2008.
Kutney-Lee, A., McHugh, M., Sloane, D., Cimiotti, J., Flynn, L., Felber Neff, D., & Aiken, L.
(2009, June 12). Nursing: A key to patient satisfaction. Retrieved from
http://www.nursing.upenn.edu/chopr/Documents/Kutney-Lee (2009) Nursing Key to Pub
Satisfaction. Health Affairs.pdf
Pronovost, P., Berenholtz, S., Dorman, T., Lipsett, P., Simmonds, T., & Haraden, C. (2003).
Improving communication in the icu using daily goals. Journal of Critical Care, 18(2), 71-75.