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Joshi M, Gokhale A, Ma S, Pendrey A, Wozniak L, Moturu A, Schwartz NU, Wilson A, Darmawan K, Phillips B, Cullum S, Sharp C, Brown G, Shieh L, Schmiesing C. "Covering provider": an effort to streamline clinical communication chaos. JAMIA Open 2024; 7:ooae057. [PMID: 38974405 PMCID: PMC11226879 DOI: 10.1093/jamiaopen/ooae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 02/19/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024] Open
Abstract
Objective This report describes a root cause analysis of incorrect provider assignments and a standardized workflow developed to improve the clarity and accuracy of provider assignments. Materials and Methods A multidisciplinary working group involving housestaff was assembled. Key drivers were identified using value stream mapping and fishbone analysis. A report was developed to allow for the analysis of correct provider assignments. A standardized workflow was created and piloted with a single service line. Pre- and post-pilot surveys were administered to nursing staff and participating housestaff on the unit. Results Four key drivers were identified. A standardized workflow was created with an exclusive treatment team role in Epic held by a single provider at any given time, with a corresponding patient list column displaying provider information for each patient. Pre- and post-survey responses report decreased confusion, decreased provider identification errors, and increased user satisfaction among RNs and residents with sustained uptake over time. Conclusion This work demonstrates structured root cause analysis, notably engaging housestaff, to develop a standardized workflow for an understudied and growing problem. The development of tools and strategies to address the widespread burdens resulting from clinical communication failures is needed.
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Affiliation(s)
- Mugdha Joshi
- Internal Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Arjun Gokhale
- Clinical Informatics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Stephen Ma
- Clinical Informatics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anna Pendrey
- Geriatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Lauren Wozniak
- Adolescent Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anoosha Moturu
- General Surgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Nicholas U Schwartz
- Neurology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Austin Wilson
- Nursing Innovation, Stanford Healthcare, Palo Alto, CA, United States
| | - Kelly Darmawan
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Brian Phillips
- Nursing Innovation, Stanford Healthcare, Palo Alto, CA, United States
| | - Stav Cullum
- Internal Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christopher Sharp
- Internal Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gretchen Brown
- Nursing Informatics, Stanford Healthcare, Palo Alto, CA, United States
| | - Lisa Shieh
- Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Clifford Schmiesing
- Anesthesia, Stanford University School of Medicine, Palo Alto, CA, United States
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Wang J, Kidd VD, Giafaglione B, Strong B, Ohri A, White J, Amin A. Improving Nurse-Physician Bedside Communication Using a Patient Experience Quality Improvement Pilot Project at an Academic Medical Center. Cureus 2024; 16:e55976. [PMID: 38469366 PMCID: PMC10927320 DOI: 10.7759/cureus.55976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Patient experience is a crucial aspect of healthcare delivery, and it encompasses various elements that contribute to a patient's perception of the care they receive. Patient satisfaction and patient experience are related but distinct concepts. Patient experience focuses on whether specific aspects of care occurred, while patient satisfaction gauges whether patient expectations were met. It goes beyond mere satisfaction and delves into the broader aspects of how patients interact with the healthcare system and the quality of those interactions, with health plans, doctors, nurses, and staff in various healthcare facilities. Other aspects highly valued by patients include elements such as timely access to care and information, good communication with the healthcare team, and friendly staff. Patient experience can influence both the healthcare and financial outcomes of healthcare facilities. It is well understood that positive patient experiences may lead to better care adherence, improved clinical outcomes, enhanced patient safety, and better care coordination. Payers, both public and private, have recognized the importance of patient experience. Improving patient experience benefits healthcare facilities financially by strengthening customer loyalty, building a positive reputation, increasing referrals, and reducing medical malpractice risk and staff turnover. Methodology A multidisciplinary retrospective quality improvement initiative was initiated to effectively improve nurse-physician communication and organizational outcomes in several hospital units. Results Using an innovative staff-developed and driven acronym, IMOMW (I'm on my way), the study demonstrated significant positive outcomes such as increased Epic documentation (Epic Systems Corporation, Verona, Wisconsin, United States) of physician and nursing rounding by 13%, a 10.5% rise in recommend facility net promoter score (NPS) patient experience survey scores, 13.4% increase in physician and nurse team communication, 5.4% increase in nursing communication, and a 5.3% increase in physician communication. Moreover, pilot units outperformed the control group consisting of medical-surgical units located in newer portions of the hospital. Conclusion This quality improvement study demonstrates improved interdisciplinary nurse-physician communication, Epic documentation, and patient experience scores. Further investigation is necessary to better understand the specific factors and/or processes that influence the sustainability of interventions that improve nurse-physician communication and patient experience.
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Affiliation(s)
- Justin Wang
- Clinical Operations, University of California Irvine Medical Center, Orange, USA
| | - Vasco Deon Kidd
- Orthopaedic Surgery, University of California Irvine School of Medicine, Irvine, USA
| | - Brad Giafaglione
- Clinical Operations, University of California Irvine Medical Center, Orange, USA
| | - Brian Strong
- Nursing, University of California Irvine Medical Center, Orange, USA
| | - Anuj Ohri
- Hospital Medicine, University of California Irvine School of Medicine, Irvine, USA
| | - Janice White
- Nursing - Medical Surgical/Telemetry, University of California Irvine Medical Center, Orange, USA
| | - Alpesh Amin
- Medicine, University of California Irvine School of Medicine, Irvine, USA
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Sarma D, Stenson B, MacDougall G, Mangino A, Sanchez LD, Chiu DT. Comparison of nurse and resident physician paging frequency by sex in the emergency department. AEM EDUCATION AND TRAINING 2024; 8:e10948. [PMID: 38510726 PMCID: PMC10950017 DOI: 10.1002/aet2.10948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 03/22/2024]
Abstract
Objectives The role of biological sex in interprofessional relationships is an important factor in collaborative health care settings such as the emergency department (ED) but one that has been sparsely studied. While there is anecdotal evidence on gender-based differences in communication, little research has focused on this topic. The goal of this study was to determine whether there are differences in paging frequency between nurses and male and female residents. Methods We conducted a retrospective review of patient visits to our urban, tertiary care academic ED between January 1 and April 1, 2021. Only pages from nurses to emergency medicine (EM) residents were included. Outcome variables included number of pages received by sex, number of unique ED visits, and mean number of pages per unique visit. Pearson's chi-square tests were used to analyze differences between observed and expected results. Results A total of 15,617 pages from nurses to residents over 6843 unique patient visits to the ED were analyzed. This included 187 nurses, 162 (87%) of whom were female and 25 (13%) were male. Of the 39 residents, 12 (31%) were female and 27 (69%) were male. Female residents received 4500 pages over 2228 unique patient ED visits, or a mean of two pages per patient with a mean of 186 unique ED visits per female resident. Male residents received 11,117 pages over 4615 unique patient ED visits, or a mean of 2.4 pages per patient, with a mean of 171 unique ED visits per male resident. This difference in pages per patient was statistically significant (χ2(1) = 369, p < 0.001). Conclusions We found that male residents received significantly more pages per patient than their female colleagues. Overall, further research is required to understand the factors, such as characteristics of patients or preferred communication methods of providers, that drive this disparity and what the implications are for patient outcomes.
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Affiliation(s)
- Deesha Sarma
- Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Bryan Stenson
- Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Gordon MacDougall
- Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Alyssa Mangino
- Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Leon D. Sanchez
- Department of Emergency MedicineBrigham and Women's Faulkner HospitalBostonMassachusettsUSA
| | - David T. Chiu
- Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
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Aziz S, Barber J, Singh A, Alayari A, Rassbach CE. Resident and nurse perspectives on the use of secure text messaging systems. J Hosp Med 2022; 17:880-887. [PMID: 36036216 DOI: 10.1002/jhm.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND As hospitals shift away from pagers and towards secure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors. OBJECTIVE This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital. DESIGN This was a qualitative study with focus groups. SETTING AND PARTICIPANTS Participants were pediatric residents and nurses at Lucile Packard Children's Hospital. INTERVENTION Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached. MAIN OUTCOME AND MEASURES Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well-being. RESULTS Three resident focus groups (n = 14) and three nurse focus groups (n = 21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face-to-face communication and frontline decision-making. (3) STMS can promote patient safety through closed-loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well-being through satisfaction and relationship building. (6) STMS can negatively impact clinician well-being through increased stress related to communication volume. CONCLUSION Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.
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Affiliation(s)
- Sara Aziz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - John Barber
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amit Singh
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Clinical Informatics, Stanford Children's Health, Palo Alto, California, USA
| | - Amethyst Alayari
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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