74: A performance improvement study to maximize multidisciplinary communication using a joint gynecology team phone

Abstract

Performance improvement (PI) represents a method for improving the quality and safety of patient care by measuring an output of a process and then modifying the process to increase efficiency and effectiveness. This PI study aimed to evaluate the effects of three simple multidisciplinary interventions to decrease the day shift call burden to the inpatient gynecologic service by anticipating floor and staff needs and communicating resident availability for non-urgent matters. This is an IRB exempt study conducted at Kaiser Permanente San Francisco. The gynecology team phone is held by the junior resident on the benign gynecology (BG) team. When the resident is scrubbed, calls are answered and messages taken by the circulating nurse or a medical student. Calls received are regarding patients on the BG or gynecologic oncology (GO) services and for Emergency Department (ED) consultations. Baseline data were collected regarding the distribution of incoming calls over a two-week period. Three interventions were implemented over the following eight weeks: (1) “closing the loop” with bedside nursing staff about the plan for the day and a verbal request to hold all non-urgent questions until PM rounds, (2) warm handoff by resident physician to post-anesthesia care unit (PACU) nurse for admission vs same-day discharge, and (3) inclusion of a “disposition” section in the AM progress note to aid the patient care coordinator (PCC) in disposition planning. Post-intervention data was collected over a three-week period and included brief interviews with nurses and residents. We hypothesized that there would be fewer incoming calls, specifically from the floor nurses and PCCs. At baseline, a total of 49 calls were received. Four were wrong numbers. The division by service was 30% GO patients and 61% BG. The sources of the calls were 16% ED, 24% Ambulatory Surgical Unit (ASU) or PACU, 22% floor nurses, 9% PCCs and 29% other services including dieticians and radiology. Post intervention, a total of 30 calls were received, 3 of which were to the wrong number. The division by service was 40% GO patients and 50% BG. The sources of the post-intervention calls were 11% ED, 26% ASU/PACU, 37% floor nurses, 11% PCCs and 15% other services. Residents and nurses reported that the work burden of the interventions was low. Overall, our study demonstrated a 36% reduction in incoming calls following a multidisciplinary intervention effort. This PI study shows that simple interventions to address likely floor and staff needs and communicating resident availability might improve use of resident time and decrease distractions in the OR on a busy inpatient service with the overall result of expediting patient care.