Background: Effective nurse-physician communication is imperative to safe, patient-centered care. Poor communication can lead to adverse events, ranging from near misses to patient deaths. It is important for information to be accurate and timely. In addition to patient safety, there are financial implications to poor communication. According to a 2015 study, communication failures in the United States hospitals and medical practices were responsible in part for 30% of all malpractice claims, resulting in 1,744 deaths, and 1.7 billion in malpractice costs over five years. Our institution administers an annual anonymous employee engagement survey. In 2018, nurse-physician communication scores (NPCS) as rated by bedside nurses were among the lowest (2.63 out of 5) on the floors with primarily resident team patients.
Purpose: In light of patient safety, financial implications, and current NPCS, it was clear that novel ways of optimizing interprofessional team communication were needed. First, we identified why communication scores were lower for resident teams. Once communication gaps were identified, processes for improvement were implemented.
Description: An interprofessional team including physicians, process improvement specialists, and nurses developed a survey with Likert scale and free text questions. This anonymous survey was distributed to 38 nurses, including day, night, and weekend shifts. This survey identified top areas for improvement that included: having a singular way to contact physicians, responding to nursing inquiries in a timely manner, and keeping nursing staff up to date on plans of care.At the time of the survey, there were multiple avenues of communication. Each team had a team pager in addition to residents’ personal pagers. Also, a new mobile device communication application was recently implemented. These multiple avenues only caused confusion for nurses and physicians, and an average of only 75% of physicians were logging into the mobile application daily. Based on survey feedback, we decided to make the mobile application the primary means of communication. This platform could improve response times due to the ability to respond from any location, via call or text. Implementation and dissemination efforts included placing flyers in resident workrooms as reminders to log in to the mobile application, multiple education sessions in resident monthly meetings, a reminder email to residents when they did not log in, and educating nursing staff that the mobile application was to be the primary means of contacting residents. By implementing these measures, resident login increased to almost 100%, and team service pagers were removed to avoid redundancy. 2019 employee engagement survey results revealed an improvement in the NPCS by 1.04. This was one of the highest improvement of NPCS in the enterprise.
Conclusions: Nurses spend more time with patients than physicians and often are tasked with explaining plans of care to patients after the physicians have left the patient’s room. If nurses have a clear understanding of the plan of care from physicians, they are empowered to accurately and clearly explain it to patients. By restructuring the way nurses and physicians communicated, we were able to improve NPCS from 2.63/5 to 3.67/5. We believe this will translate into improved quality, safety, and patient-centered care along with making the workflow easier and more enjoyable for nurses and physicians.