Background:
Quality and patient safety initiatives are often role-specific with minimal emphasis on cross-discipline collaboration and communication. Prior to project implementation, each discipline’s patient care plans were made in silos without an aligned emphasis on quality and safety initiatives. With implementation of a daily interdisciplinary safety brief based on a shared mental model, our aim was to reduce inpatient falls, improve discharge coordination, and to impact provider communication and teamwork, as well as other quality and safety metrics.
Methods:
In November 2014, TeamSTEPPS® methodology, an evidence-based teamwork and communication tool, was utilized to implement a daily safety brief on two acute care medical units (17 East and 17 West) at an urban academic medical center. Members of the interdisciplinary team, including nurses, patient care technicians, physicians, and unit clerks, meet daily from 8:30-8:45 am. A checklist was developed to ensure topics covered include patients at increased risk for fall, patients at increased risk for pressure ulcers, clinical ‘hot-spots’ (abnormal vital signs, overnight events, behavioral issues), uncontrolled pain, discharge before noon (DBN) review, goals of care compliance, unit announcements, quality metrics, and daily state of the medicine service (including bed availability and emergency department volume). During this time, each unit also focused efforts on a specific quality improvement project – increasing hand hygiene compliance for 17 East and decreasing incident Clostridium difficile rates for 17 West. We measured fall rates and discharge before noon rates on both units, as well as hand hygiene compliance for 17 East and C. difficile rates for 17 West, for the three quarters prior to project implementation (Quarters 1-3, 2014), as compared to the three quarters after project implementation (Quarters 1-3, 2015).
Results:
The average fall rate on 17 East improved from 4.12 falls per 1,000 patient days to 2.82, a 32% reduction. The average fall rate on 17 West improved from 2.07 to 1.43, a 31% reduction. Average DBN rates improved from 30% to 40%, a 33% increase, on 17 East, and increased from 34% to 48%, a 41% improvement, on 17 West. Average hand hygiene compliance measured by direct observation of antimicrobial product use for 17 East improved from 70% to 74%. Average incident C. difficilerates measured as number of cases per 1,000 patient days for 17 West improved from 1.89 to 1.13 representing a 38.9% reduction.
Conclusions:
Fostering a shared mental model utilizing an evidence-based communications and teamwork tool such as TeamSTEPPS® facilitates better collaboration amongst healthcare professionals. Creating a standard of communication around core unit and service quality and safety initiatives leads to improvements in efficiency, effectiveness and patient safety.