Improve Team Communication Research Articles

The use of the ambulatory procedure room for carpal tunnel release

INTRODUCTION: Crew Resource Management (CRM) training is a well-accepted cultural change methodology that has been used in healthcare settings to improve team communication and reduce the number of avoidable medical errors. Data is limited regarding the actual return on investment (ROI) for implementing such training. We hypothesize, that despite a seemingly high investment to complete this training, a positive return on investment can be measured, thereby supporting the benefit of such training.

Using Simulation Education With Deliberate Practice to Teach Leadership and Resource Management Skills to Senior Resident Code Leaders.

Cardiopulmonary arrests are rare, high-stakes events that benefit from using crisis resource management (CRM). Simulation-based education with deliberate practice can promote skill acquisition. We assessed whether using simulation-based education to teach CRM would lead to improved performance, compared to a lecture format. We tested third-year internal medicine residents in simulated code scenarios. Participants were randomly assigned to simulation-based education with deliberate practice (SIM) group or lecture (LEC) group. We created a checklist of CRM critical actions (which includes announcing the diagnosis, asking for help/suggestions, and assigning tasks), and reviewed videotaped performances, using a checklist of skills and communications patterns to identify CRM skills and communication efforts. Subjects were tested in simulated code scenarios 6months after the initial assessment. At baseline, all 52 subjects recognized distress, and 92% (48 of 52) called for help. Seventy-eight percent (41 of 52) did not succeed in resuscitating the simulated patient or demonstrate the CRM skills. After intervention, both groups (n = 26 per group) improved. All SIM subjects announced the diagnosis compared to 65% LEC subjects (17 of 26, P = .01); 77% (20 of 26) SIM and 19% (5 of 26) LEC subjects asked for suggestions (P < .001); and 100% (26 of 26) SIM and 27% (7 of 26) LEC subjects assigned tasks (P < .001). The SIM intervention resulted in significantly improved team communication and cardiopulmonary arrest management. During debriefing, participants acknowledged the benefit of the SIM sessions.

Improving safety and quality of care with enhanced teamwork through operating room briefings.

To describe the current state of the science for operating room (OR) briefings and debriefings, including an overview of key definitions, a review of the evidence of effectiveness, and a summary of our experiences as part of a comprehensive unit-based safety program. Use of preoperative briefings has been shown to improve team communication, decrease disruptions to surgical workflow, improve compliance with antibiotic and deep vein thrombosis prophylaxis, and improve overall perceptions about the safety climate in the OR. Studies have demonstrated that an effective briefing can be performed in less than 2 minutes and reduce delays by more than 80%. Effective implementation involves changing workflows and expectations of interaction among OR team members, including participation from leaders at all levels. Briefings and debriefings are a strategy for revealing defects and facilitating adaptive change in the OR. Briefings and debriefings are a good method for improving teamwork and communication in the OR. Effective implementation may be associated with improved patient outcomes. Commitment by the participating providers is essential for effective briefings, which include discussion of relevant information pertaining to the procedure.

Checklist-styled Daily Sign-out Rounds Improve Hospital Throughput in a Major Trauma Center

The checklist concept has received much attention as a result of its ability to improve patient care by minimizing complications. We hypothesized daily sign-out rounds using a checklist, by improving team communication and consistency of clinical care, could lead to expedited throughput for patients at a major trauma center. A retrospective study examined patients admitted to a mature trauma center. Two time periods, PRE (September 2008 to January 2009) and POST (September 2009 to January 2010), were selected to match for seasonal variation in admission diagnosis. An organ system-based checklist was used during daily sign-out for all admitted trauma patients in the POST period. We examined discharge status, complications and rates, and intensive care unit (ICU) and overall hospital length of stay for differences. There were similar numbers of patients (824 PRE vs 798 POST) admitted in these two cohorts. We found no statistical differences in the incidence of complications or mortality rate. We did discover statistically significant differences in the median ICU days (2 PRE vs 1 POST, P = 0.007) as well as median hospital length of stay (2 days, interquartile differences Q1 to Q3 PRE [1 to 5] and POST [1 to 4] P = 0.000). These trends remained valid even among the severely injured (Injury Severity Score 16 or greater) with a hospital length of stay of 5 (PRE) versus 3 days (POST; P = 0.021). A simple, organ system-based checklist can be successfully adopted for daily sign-out round on a busy, multiprovider trauma service. We were able to expedite trauma patient throughput in both ICU and overall hospital stays with a trend toward decreasing mortality. This improved throughput may potentially translate into a cost saving for the hospital.

VA Experience in Implementing Patient-Centered Medical Home Using a Breakthrough Series Collaborative

Veterans Health Administration (VHA) seeks to improve the delivery of patient-centered care. A Patient-Centered Medical Home (PCMH) Model, named Patient Aligned Care Team (PACT), was implemented to transform the VHA primary care delivery process. VHA used a collaborative learning model as a key approach to disseminate PACT concepts and changes. To describe and examine VHA's experience disseminating PACT transformation using a Breakthrough Series Collaborative method. Observational study. Approximately 250-350 individuals from 141 teams participated in six face-to-face learning sessions across 21 months. 1) PACT Collaborative participant surveys; 2) Coach Assessment Scores and Plan-Do-Study-Act (PDSA) data; and 3) PACT Compass (national measures to assess PACT implementation within VA healthcare system). A majority of the participants indicated that the PACT Collaborative was necessary to implement PACT. The number of PDSAs increased steadily during the Collaborative period; 93 % (n = 1,547) of PDSAs were successfully implemented. Teams successfully achieved over 80 % of their aims, which were highly correlated with PDSAs implemented (R(2) = 0.88). The most successful aims achieved were offering same-day appointments, increasing non-face-to-face care, and improving team communication. PACT Compass indicated an improvement after the Collaborative (p-value < .000), and providers observed differences in their care practice (p-value < 0.002). This positive impact may be due to the spread of the PACT Model through the PACT Collaborative, among other learning initiatives. For complex collaborative models such as PACT, more than three learning sessions may be required. As VHA continues to disseminate the PACT Model through primary care, into specialty/surgical care and beyond, the Collaborative Learning Model may continue to be an effective way to leverage a small number of faculty, coaches, and industrial engineers across an extremely large population.

Are Systems‐Centered® teams more collaborative, productive and creative?

PurposeResearch from numerous theories shows teams' information sharing and discussion enhances effectiveness. Likewise, team communication structure can increase information sharing, manage conflict productively and foster creativity. However, the lack of unifying theory hinders understanding of the disparate research findings. Agazarian aims to unify the field with her meta‐theoretical, multi‐level Theory of Living Human Systems (TLHS). Furthermore, her TLHS‐derived Systems‐Centered Training (SCT) presents an innovative structure to improve team performance. The purpose of this paper is to compare the verbal process, productivity, and creativity of pre‐existing work groups using SCT methods or Robert's Rules of Order (RRO), to test TLHS/SCT reliability and validity.Design/methodology/approachThe verbal characteristics, information sharing, productivity, and creativity in SCT and RRO teams were compared using the System for Analyzing Verbal Interaction (SAVI), Group Productivity Scale and Work Group Inventory.FindingsSCT teams, compared to groups using RRO, talked in ways more likely to transfer and integrate task‐related information. Furthermore, SCT teams were more productive, better performing, and more creative.Research limitations/implicationsThe study's design does not permit cause‐and‐effect conclusions. Proposals for future research are made.Practical implicationsThe results suggest SCT methods improve team communication, productivity, and creativity. Because this study examined “real‐world” teams, the findings may apply to similar groups in various workplaces.Social implicationsHaving the ability to use differences as resources could improve society.Originality/valueThis paper suggests SCT methods offer innovative communication structures that focus teams effectively, perhaps by minimizing off‐task communications and conflict. Also, as SCT operationally defines TLHS, these results support the validity of TLHS.

How do nurse practitioners in acute care affect perceptions of team effectiveness?

To describe how acute care nurse practitioners affect perceptions of team effectiveness. Acute care nurse practitioners provide safe and effective care to patients. There is limited evidence of the effects of acute care nurse practitioner roles on healthcare teams, and many of the findings are contradictory. Research is lacking to describe how nurse practitioners affect perceptions of team effectiveness. A descriptive multiple-case study undertaken in two university-affiliated teaching hospitals in Canada. Data were collected from March-May 2009. Data sources included interviews (n=59), time and motion study, non-participant observations, documents and field notes. Interviews were conducted individually or in groups using a semi-structured interview guide. Data were analysed within and across the cases to identify similarities and differences in perceptions of team effectiveness. Team members believed the nurse practitioners improved the team's effectiveness. They identified six team processes they believed were improved by the addition of the nurse practitioners to the teams. The processes included decision-making, communication, cohesion, care coordination, problem-solving and focus on patients and families. The study contributes to our understanding of how nurse practitioners affect perceptions of team effectiveness. Improved team communication and care coordination were believed to be particularly important. Nurse practitioner can facilitate patient- and family-centred care in healthcare teams. Nurse practitioners improve perceptions of team effectiveness. Further work is needed in different contexts and with patients and families to determine their perceptions of team effectiveness. The nurse practitioner role was believed to be particularly important to improve team communication and care coordination. This constitutes an added value of acute care nurse practitioners roles in healthcare teams. Nurse practitioner roles contribute to patient-centred care and can improve the quality and safety of the care provided to patients and families.

Reducing conflict on wards by improving team communication

Aggression in healthcare settings is a significant problem for patients and staff teams. The acute inpatient ward is no exception, especially when the conflict is in the form of verbal aggression. The authors’ developmental work has shown that existing strategies and training for dealing with conflict and verbal aggression are limited due to a focus on de-escalation and physical interventions, and a lack of attention to the finer details of communication. For training to be effective it should tap into communication systems at the individual and team level to reduce the likelihood of conflict situations escalating. Ward-based workshops using the forum theatre technique can help staff to reflect on the management of difficult situations and the communication style and system in which conflict is more likely to occur.

VTrain: A Novel Curriculum for Patient Surge Training in a Multi-User Virtual Environment (MUVE)

During a pandemic influenza, emergency departments will be overwhelmed with a large influx of patients seeking care. Although all hospitals should have a written plan for dealing with this surge of health care utilization, most hospitals struggle with ways to educate the staff and practice for potentially catastrophic events. Hypothesis/Problem To better prepare hospital staff for a patient surge, a novel educational curriculum was developed utilizing an emergency department for a patient surge functional drill. A multidisciplinary team of medical educators, evaluators, emergency preparedness experts, and technology specialists developed a curriculum to: (1) train novice users to function in their job class in a multi-user virtual environment (MUVE); (2) obtain appropriate pre-drill disaster preparedness training; (3) perform functional team exercises in a MUVE; and (4) reflect on their performance after the drill. A total of 14 students participated in one of two iterations of the pilot training program; seven nurses completed the emergency department triage course, and seven hospital administrators completed the Command Post (CP) course. All participants reported positive experiences in written course evaluations and structured verbal debriefings, and self-reported increase in disaster preparedness knowledge. Students also reported improved team communication, planning, team decision making, and the ability to visualize and reflect on their performance. Data from this pilot program suggest that the immersive, virtual teaching method is well suited to team-based, reflective practice and learning of disaster management skills.

Abstract TP355: Supporting and Sustaining Systems Change Through the Development of Common Standards of Stroke Care

Background/Issues: The Stroke Flow initiative is a system-wide redesign of stroke services to enhance access to stroke best practices. Specifically, its focus is to ensure access to acute stroke units and timely and appropriate rehabilitation. To support this work, the Toronto Stroke Networks (TSNs) held forums with stroke nursing leaders (SNLs) within the Greater Toronto Area (GTA). Purpose: Through these forums, the purpose of this work was to develop evidenced-informed common standards of stroke care across the continuum and set priorities for implementation within the GTA. Methods: Six forums (from December 2011 to June 2012) were held for 43 SNLs from 16 acute and rehabilitation hospitals within the GTA. Using an appreciative inquiry approach, meetings focused on: 1) identifying common core elements (CCEs) for stroke care; 2) validating CCEs through consultation with interprofessional stroke teams; 3) forming consensus on CCEs; 4) identifying organizational priorities for implementation planning using thematic analysis; 5) integrating CCEs into existing processes of care; and 6) sustaining this work through the establishment of a stroke community of practice. Results: Through collaborative planning, CCEs were developed and reflect current and emerging best practices. Preliminary results from thematic analysis identified priorities related to: transitions of care, improved team communication processes, patient/family education, and integration of outcome measures across the care continuum. Conclusions: Common core elements of stroke care were collectively developed by the TSNs, stroke nursing leaders, and interprofessional teams to promote a standardization of stroke care that integrates best practices and identifies areas for improvement. Impact of this work has led to the development of CCE documents to support the integration and standardization of stroke care and the establishment of a stroke nursing community of practice. Final thematic analysis is currently underway to further identify priorities for implementation.

1881 Systematic Method to Improve Management of Critically ill Children

BackgroundAkershus University Hospital is the largest acute care hospital in Norway. It employs 6.200 people to serve 460.000 inhabitants, of which 115.000 are children. Currently, our Department is experiencing an...

Impact of benchmarking and clinical decision making tools on rehabilitation length of stay following spinal cord injury

Performance improvement initiative. To improve efficiency of spinal cord rehabilitation by reducing length of stay (LOS) while maintaining or improving patient outcomes. Academic hospital in Canada. LOS benchmarking was completed using national comparator data from the Canadian Institute for Health Information (CIHI). Clinical decision-making tools were developed to support implementation and sustainability. A standardized 'tentative discharge date' calculator was created to establish objective LOS targets. Defined discharge criteria and an accompanying clinical decision tree were developed to support team decision making and improve transparency. A revised patient census tool was also implemented to improve team communication and facilitate data collection. The initiative was implemented in March 2010 and the following metrics were evaluated: LOS, Functional Independence Measure (FIM) change and FIM efficiency. Outcomes are reported for the 2010/11 fiscal year, and compared with the two prior fiscal years. Mean LOS for individuals undergoing initial inpatient rehabilitation was 71.5 days for 2010/11, a 14 and 17% reduction compared with the 2008/09 and 2009/10 fiscal years, respectively. While LOS decreased, FIM change increased 9 and 16% compared with 2008/09 and 2009/10, respectively. Similarly, FIM efficiency increased 54 and 32% compared with 2008/09 and 2009/10. The use of benchmarking and decision support tools improved rehabilitation efficiency while increasing standardization in practice and transparency in LOS determination.

Team Composition and Perceived Roles of Team Members in the Trauma Bay

Perceptions of trauma team members and their roles may impact team performance, requiring intervention. Participant observation and semistructured interviews were performed with trauma team members: attendings, nurses, fellows, residents, and medical students. Some team members do not include nurses as members of the team. A greater proportion of male than female team leaders perceived their role as teacher or educator. Nurses, attendings, and fellows, provided parallel descriptions of good leaders, whereas medical students and residents stressed other qualities. Inconsistencies in trauma team role definition and membership should be addressed, toward the goal of improving team communication and patient outcomes.

A Novel Paradigm for Providing Improved Care to Chronic Patients in Cardiac Intensive Care Unit

Evaluate the impact of chronic cardiac care team (CCCT) on hospital course of patients, their families, and nursing staff. Retrospective observational study in children with hospital stay of ≥6 weeks in a pediatric cardiac intensive care unit (CICU) at a tertiary care children's hospital. Before and after care, survey of the nurses and patients family was also performed. The CCCT provided care for 68 patients of which 44 survived to discharge. Median age at admission was 19 days (range 0-20.6 years); 18 (26%) were admitted at birth. Cardiac diagnosis included single ventricle in 27, heart failure/cardiac transplantation in 37, others in 6. The CCCT was involved in follow-up for vitamin and endocrine deficiencies, updating immunization status, optimizing nutritional intake, growth parameters, assess feeding issues, and providing end-of-life discussions in all those who died. One year after implementation, 85% nurses indicated improved understanding of patient problems, 57% reported improved working relationship with families, and 87% reported improved team communication. Family survey indicated that implementation of the model led to significantly improved opinion of parents in their ability to participate in the plan of care (28% vs. 70%, P = 0.019) and better relationship with the CICU staff caring for their child (57% vs. 100%, P = 0.008). The CCCT provides a new team-based paradigm for improving continuity of care in chronic CICU patients by supplementing medical care and facilitates end-of-life discussions. The CCCT bridges communication gap between CICU staff and families.

Bringing Employees Closer: The Effect of Proximity on Communication When Teams Function under Time Pressure

Some studies have assumed close proximity to improve team communication on the premise that reduced physical distance increases the chance of contact and information exchange. However, research showed that the relationship between team proximity and team communication is not always straightforward and may depend on some contextual conditions. Hence, this study was designed with the purpose of examining how a contextual condition like time pressure may influence the relationship between team proximity and team communication. In this study, time pressure was conceptualized as a two‐dimensional construct: challenge time pressure and hindrance time pressure, such that each has different moderating effects on the proximity–communication relationship.The research was conducted with 81 new product development (NPD) teams (437 respondents) in Western Europe (Belgium, England, France, Germany, and the Netherlands). These teams functioned in short‐cycled industries and developed innovative products for the consumer, electronic, semiconductor, and medical sectors. The unit of analysis was a team, which could be from a single‐team or a multiteam project. Results showed that challenge time pressure moderates the relationship between team proximity and team communication such that this relationship improves for teams that experience high rather than low challenge time pressure. Hindrance time pressure moderates the relationship between team proximity and team communication such that this relationship improves for teams that experience low rather than high hindrance time pressure.Our findings contribute to theory in two ways. First, this study showed that challenge and hindrance time pressure differently influences the benefits of team proximity toward team communication in a particular work context. We found that teams under high hindrance time pressure do not benefit from close proximity, given the natural tendency for premature cognitive closure and the use of avoidance coping tactics when problems surface. Thus, simply reducing physical distances is unlikely to promote communication if motivational or human factors are neglected. Second, this study demonstrates the strength of the challenge–hindrance stressor framework in advancing theory and explaining inconsistencies. Past studies determined time pressure by considering only its levels without distinguishing the type of time pressure. We suggest that this study might not have been able to uncover the moderating effects of time pressure if we had conceptualized time pressure in the conventional way.

NP010 A unit level toolkit to optimize heart failure care across different organizations

The prevalence of heart failure is increasing due to our aging population and improvement and diagnosis of myocardial infraction (Johanssen and Strauss, 2003).While heart failure guidelines and clinical pathways have been well published across North America and some of the European countries, there is still some practice variation in the adherence to these guidelines. (NHS Guideline, 2009) Initial research at a Canadian tertiary care centre indicated a 10-20% over the national average for in-hospital mortality for HF patients and 50% over the national average for readmission rates and a higher than the national average LOS. A pilot project to optimize care was initiated and completed on two medical cardiology units focusing on improving team communication, use of the order sets to reduce practice variation and patient education and follow up. Unit level involvement was sought and five key improvement areas were identified. These changes are now being disseminated hospital wide. This presentation will discussed and summarize a toolkit that was used successfully by frontline managers and educators in bringing out the change and improvement in clinical processes at the direct care provider level in order to prioritize and optimize heart failure care. This toolkit is being reviewed as a prototype for other centres wishing to optimize heart failure care.

Development of a design performance measurement matrix for improving collaborative design during a design process

PurposeThe purpose of this paper is to investigate how to measure collaborative design performance and, in turn, improve the final design output during a design process, with a clear objective to develop a design performance measurement (DPM) matrix to measure design project team members' design collaboration performances.Design/methodology/approachThe methodology adopted in this research uses critical literature reviews, in‐depth focus group interviews and a questionnaire survey.FindingsThe main finding of this study is a DPM matrix that addresses five DPM indicators: efficiency, effectiveness, collaboration, management skill, and innovation, and 25 detailed DPM criteria. It was found that decision‐making efficiency is the most important DPM criterion for collaborative design efficiency; plus delivering to the brief for effectiveness; clear team goal/objectives for collaboration; decision‐making ability for management skill; and competitive advantage for innovation.Research limitations/implicationsAs the present study was focused on exploring DPM during a design process, some key DPM criteria which are not measurable during a design development process were not included in this study. The proposed multi‐feedback approach for DPM matrix implementation needs to be validated in future research.Practical implicationsThe DPM matrix can be applied to support a design manager in measuring and improving collaborative design performance during a design process, by reviewing and modifying collaborative design development, identifying the design team strengths and weaknesses, improving team communication, and suggesting suitable responsive actions.Originality/valueThe major contribution of this study is the investigation and development of a DPM matrix to measure collaborative design performance during a design process.

Positive Impact: Integrating Palliative Care Education and Support in a Community Oncology Practice (728)

1.Describe a novel pilot program integrating palliative care education and support into a community oncology practice.2.Identify two program components which decreased the percentage of patients receiving chemotherapy within 14 days of death, increased documented advance directives at the time of death, and improved staff satisfaction with end-of-life care. Background. Increasingly, cancer patients experience chronic illness prior to clinical decline and death. Predicted growth in the number of cancer patients will require better integration of palliative care in oncology practice to best serve patient and provider needs. In 2006, Northwest Cancer Specialists (NCS), a community oncology practice comprising 41 medical, radiation, and gynecologic oncologists at seven service sites, targeted improved palliative/end-of-life care as goals and initiated the CARES program. Research objectives. (1) Increase staff palliative care education/support. (2) Improve team communication about care goals, symptom management, and advance ccare planning (ACP). (3) Improve staff satisfaction with care delivered at end of life. (4) Increase percentage of patients receiving hospice services and with advance directives (AD) at the time of death. (5) Decrease percentage of patients receiving chemotherapy within 14 days of death. Methods. Two grants funded CARES activities at three sites over 18 months. Curriculum included communication workshops, education about decision making during treatment transitions, patient/family support, and ACP. A care conference model was implemented to facilitate discussion of patients with complex symptom management and psychosocial needs. Patient deaths (687) were reviewed in detail. Staff members were surveyed to assess satisfaction with patient care before and after program implementation. Results. (1) Seventy-five percent of staff reported improved access to patient support services; 54% of RNs reported greater confidence in skills. (2) Percentage of patients receiving chemotherapy within 14 days of death declined: P = 0.0255. (3) Percentage of patients receiving hospice: non-significant trend toward improvement. (4) Percentage of patients with documented AD improved: P = 0.0275. Conclusion. This novel palliative care education/support program in a community oncology practice resulted in increased staff satisfaction and improvement in quality metrics. Implications for research, policy, or practice. Internal practice education/support programs benefit patients and providers and could enhance implementation of palliative care principles and skills to serve the growing oncology patient population across the continuum of care.

Use of the WHO surgical safety checklist in trauma and orthopaedic patients

The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations. The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions. Data was collected on 480 patients before the educational program and 485 patients after. Pre-training checklist use was 7.9%. The rates of early complications and mortality were 8.5% and 1.9%, respectively. Forty-seven percent thought the checklist improved team communication. Following an educational program, checklist use significantly increased to 96.9% (RR12.2; 95% CI 9.0-16.6). The rate of early complications and mortality was 7.6% (RR 0.89; 95% CI 0.58-1.37) and 1.6% (RR 0.88; 95% CI 0.34-2.26), respectively. Seventy-seven percent thought the checklist improved team communication. Checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery. Education programs can significantly increase accurate use and staff perceptions following implementation.

Intraoperatives Controlling

It has been proven that pre-operative and postoperative surgical safety checklists designed to improve team communication and consistency of care are useful tools to improve surgical outcome. The aim of this study was to investigate the effectiveness of intra-operative consultation (IOC) with regard to its feasibility. IOC comprises an assessment of definite pathways in the operative procedure by another surgeon present in the operating theatre in a consultative capacity during specific steps of the operation. Between January and December 2008 a total of 2,004 operations were evaluated according the IOC. Data on the frequency of the feasibility of IOC and on whether IOC led to decisions influencing the course of the procedure were analyzed. A total of 1,369 IOCs were carried out including regular IOC in 1,102 cases (80%) and tactical IOC in 267 cases (20%). In 90 cases (7%) consultation resulted in minor changes and in 100 cases (7%) major clinically relevant revision of the operative strategy was deemed necessary. It was found that IOC is feasible in the majority of operations. In the case of tactical IOC a large number of treatment-relevant decisions are taken. This means that in the area of operative disciplines IOC represents a potential preventive strategy within the framework of quality management and a useful addition to the WHO checklist to improve safety in surgery.