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Abstract

Introduction: Although many pediatric intensive care units (PICUs) use tools to highlight goals after daily rounds, the optimal format for one such tool, the beside communication sheet (BCS), is unknown. Methods: PICU fellows, attendings, hospitalists and day and night nurses at a large academic children's hospital were polled regarding communication within the PICU, as well as requesting specific recommendations for improving the existing BCS. Using these recommendations, a revised BCS was created and implemented, which included more focused prompts and questions while removing less useful information. Three months after implementation, PICU staff were re-polled regarding PICU communication as well as the effectiveness of the revised BCS. Compliance for completing the daily BCS was monitored pre-implementation of the revised BCS as well as 3 months post-implementation. Results: After implementation of the revised BCS, there was an increase in the percent of people reporting "excellent" or "very good" day-to-day communication within the PICU, from 57% to 77%, (p= .01). 77% of PICU staff either "strongly agreed" or "agreed" that the revised BCS improved the overall care of PICU patients compared to 58% for the original BCS (p= .03). The percentage of people rating the BCS as "excellent" or "very good" increased from 33% for the initial BCS to 73% ( p< .0002). The percent of people reporting that they "always" use the BCS in their daily routine increased from 26% to 48% after implementation of the new BCS (p= .01). A number of improvements were noted regarding the revised BCS. PICU staff "strongly agreed" or "agreed" with the following: 87% thought that the revised BCS more clearly described the daily goals, 74% thought the team more consistently discussed daily reminders (like removing central lines and foleys), and 61% thought that the team more consistently discussed plans and orders for the next day, (like morning extubations, chest x-rays, and laboratory tests). 58% of the PICU staff reported "strongly disagreeing" or "disagreeing" that filling out the new BCS was cumbersome. Compliance for completing the BCS increased significantly (75% vs 83%, p = .03). Additionally, there was a significant increase in compliance in fully completing the Daily Reminders section of the BCS (10% vs 82%, p< .002). Conclusions: Introduction of a focused and concise BCS tailored to a specific PICU can lead to improved opinions of communication by medical and nursing staff, as well as significantly increased compliance in completing the daily BCS.