Improve Patient Safety with ED Communication Tools
Communication and coordination between caregivers have become synonymous with higher patient safety, satisfaction, and quality. In fact, the Joint Commission recently placed communication center stage in its 2006 patient safety goals, including a requirement that organizations demonstrate a standardized approach to "hand off" communications as of January 2006.2
Organizations with excellent communication use many tools. Here are three ED communication tools that deliver.
1. Huddle Staff at Shift Changes
"We use 'stand-up' meetings to gather everyone at the time clock for five or ten minutes just before a new shift starts," explains Leigh Knox, RN, Patient Care Manager at Sacred Heart Hospital's level 2 pediatric trauma center and emergency department in Pensacola, FL. "By quickly covering anything new that's going on and sharing what we are working on, the meetings hardwire communication between day shifts, nights, and weekends. It's a win for patients, physicians, and employees."
Everyone in Sacred Heart's ED also carries a pocket card to maintain alignment on organizational priorities that impact patient satisfaction. They include a reminder to attend stand-up meetings; keep patients informed; use pain protocols; use key words from the patient satisfaction survey (e.g., "We want to provide excellent care"); and bedside reports (below). See sidebar to download a sample pocket reminder card.
2. Use Bedside Reports
With bedside reports, the nurse reports off to the nurse who will assume the patient's care during the change of shift at the patient's bedside. This has a number of benefits. First, it creates a partnership with patients so that they feel informed and experience less anxiety as they witness well-coordinated care. It also reduces medication errors and miscommunication about the patient's condition. It certainly limits the opportunity for nurses to talk about patients negatively. In fact, it even provides a mentoring and training opportunity when a more experienced nurse can review decisions made by a nurse new to the ED and give recommendations privately after the bedside report.
A bedside report might sound like this: "Hello Mrs. Smith. We wanted to go over your care today. Your nurse for the next shift is Kendra. Kendra's been working in the ED for 15 years. She's an experienced and certified trauma nurse. Now Kendra, I want to tell you that Mrs. Smith had pain medication about 15 minutes ago, but she's not comfortable yet. We're waiting to see if this dose will take effect or if she will need a second dose. Her labs have been drawn and will be back in about 20 minutes. Her IV is hung and her IV site looks good."
3. One-on-One Meetings with Employees
The emergency department at Advocate's Good Samaritan Hospital in Downers Grove, IL, a level 1 trauma center, sees 46,000 patients per year. Communication is key. One way that ED Manager Lynn Polhemus ensures alignment and hardwires communication is by meeting individually once a year with each of her employees.
The half hour meeting covers a lot of ground, ranging from a review of specific ED goals in quality and patient-physician-employee satisfaction to behavior standards and continuing education requirements. At the end of the meeting, each individual is asked to sign a document for his or her personnel file which details the employee's commitment to addressing items covered; lists things they believe are done well in the ED; identifies opportunities for improvement; and concerns discussed. (See sidebar to download a sample of Good Samaritan's one-onone meeting form.)
2 Joint Commission on Accreditation of Health Care Organizations, 2006 Critical Access Hospital and Hospital National Patient Safety Goals, Goal 2e: "Implement a standardized approach to "hand off " communications, including an opportunity to ask and respond to questions."