Standardized Communication Tool Research Articles

Don’t drop the baton: A multidisciplinary and interprofessional approach to improving transfer of accountability and information transfer (TOAI).

3 Background: Cancer care involves complex transitions across facilities, services and providers. Optimal TOAI is critical to ensuring safe transitions in care. In 2018, the Princess Margaret (PM) Cancer Centre, Division of Medical Oncology and Hematology (DMOH), Quality Program conducted a multi-incident analysis to identify trends in patient transfer-related events (TRE). Priority areas for quality improvement included (1) use of standardized verbal communication, (2) timeliness of handover and (3) documentation. The PM TOAI Working Group (WG) was established to tailor, standardize, implement and evaluate optimal TOAI practices across PM, with the objective of eliminating TRE by 2024. Methods: The WG was established with multi-disciplinary and inter-professional representation across PM services, and met monthly. A needs assessment and environmental scan were completed. Change initiatives were prioritized, and WG focused on developing standards of work (SOW), educational approaches, and evaluation. This work coincided with University Health Network (UHN)’s adoption of I-PASS as the institution’s preferred handover tool, and I-PASS was embedded in all standards created. Change initiatives were: (1) An inter-/intra-facility TOAI SOW was developed (2) A nursing workflow mandating verbal/written handover with patient re-assessment within 1hr of transfer was created (3) Physician (MD) safety huddles with a focus on TOAI in acute oncology clinics and inpatient wards were established, and (4) Evening/weekend inpatient MD handovers were restructured and standardized. From Oct 2021 to Dec 2023, the TOAI WG completed eight cycles of PDSA change initiatives. Pre- and post-implementation surveys were conducted to identify and address barriers. Audits were used to evaluate consistency & quality of inpatient handover rounds. Results: PM reported a serious safety event rate per 10 000 adjusted patient days (SSER) of 1.24(2016); this has been reduced to 0.29 (2024). From 2013-2018, TRE occurred at PM with intervals ranging from 1 to 38 days. In the latter half of 2018, since establishing the TOAI WG, there was a gap of 123 days before the most recent event occurred. The current days between events is > 800 as of May 2024. Conclusions: Systematic implementation of TOAI initiatives at PM has improved the safety and effectiveness of patient care transitions through the adoption of tailored, standardized communication tools and targeted education, which has facilitated a sustained culture shift toward TOAI. These initiatives have reduced SSEs and fostered better communication and collaboration amongst healthcare providers. The sustained improvements highlight the significance of broad engagement of front-line staff and continuous evaluation in ensuring safe, high quality healthcare practices.

ISBAR Communication Guideline: An Innovative Strategy to Facilitate Civility Among Prelicensure Nursing Students.

Competency in communication and collaboration is essential in forming interprofessional partnerships for nursing practice. However, many students in nursing programs struggle with professional oral and written communication, leading to poor communication and incivility. Generational differences and expectations exacerbate communication breakdown and incivility among students and faculty. Implementing communication guidelines using a standardized communication tool in a traditional bachelor of science in nursing program helped facilitate professional and civil communication between students and faculty. Using the standardized tool improved student civility, professionalism, and accountability.

Maxillary osteonecrosis of the jaw. A multidisciplinary approach, communication strategies, and technological tools for prophylaxis

Background. Maxillary osteonecrosis, particularly medication-related osteonecrosis of the jaw (MRONJ), necessitates prompt identification and a comprehensive approach for effective management. Early diagnosis and proactive dental care are crucial in mitigating the complications associated with this condition. Aims. This study aims to outline the importance of early detection, multidisciplinary collaboration, patient education, and proactive dental care in the management of maxillary osteonecrosis. Methods. The study emphasizes the utilization of standardized medical letters to facilitate communication between prescribing physicians and dentists, while ensuring the timely exchange of essential patient information. Additionally, patient education plays a pivotal role, with the distribution of informative leaflets at the initiation of Bone Modifying Agents (BMA) treatment, emphasizing the risks associated with MRONJ and the significance of maintaining oral health and making appropriate lifestyle choices. Results. Dentists are key stakeholders in the prophylaxis of MRONJ, undertaking primary and secondary prevention measures. Primary prophylaxis encompasses various dental procedures aimed at reducing bacterial load and mucosal irritation. Secondary prophylaxis involves educating patients on maintaining optimal oral health and adopting lifestyle modifications. Furthermore, an Android application assists dentists in assessing MRONJ risk factors and making informed treatment decisions based on factors such as BMA type, dose, duration of administration, and the presence of dental and general risk factors. Conclusions. In conclusion, a proactive approach to managing Maxillary Osteonecrosis involves early detection, multidisciplinary collaboration, patient education, and proactive dental care. By integrating standardized communication tools, patient education materials, and risk assessment technology, healthcare providers can optimize patient outcomes and minimize the incidence and severity of MRONJ complications.

The SBAR tool for communication and patient safety in gynaecology and obstetrics: a Tunisian pilot study

BackgroundIn healthcare, inadequate communication among providers and insufficient information transmission represent primary contributors to adverse events, particularly in medical specialties such as obstetrics and gynecology. The implementation of SBAR (Situation-Background-Assessment-Recommendation) has been proposed as a standardized communication tool to enhance patient safety. This study aims to evaluate the knowledge, attitudes, and practices related to SBAR communication through a pilot study conducted in a middle-income country.MethodsThis prospective longitudinal study took place in the gynecology-obstetrics department of a Tunisian university hospital from May to June 2019. All medical and paramedical staff underwent comprehensive theoretical and practical training through a 4-hour SBAR simulation. To gauge participants’ knowledge, anonymous multiple-choice questionnaires were administered before the training initiation, with a second assessment conducted at the end of the training to measure satisfaction levels. Two months later, the evaluation utilized questionnaires validated by the French National Authority for Health (HAS).ResultsAmong the 62 care staff participants in this study, a majority (89%) demonstrated a low level of knowledge regarding the SBAR tool. The majority (75.8%) expressed enjoyment with the training and indicated their intention to implement changes in their practice by incorporating the SBAR tool in the future (80.7%). Notably, over half of the participants (79%) expressed satisfaction with the training objectives, and 74% reported acquiring new information. Evaluation of the practice revealed positive feedback, particularly in terms of clarity, the relevance of communication, and the time spent on the call.ConclusionOur pilot study showed that the majority of professionals on the ward had little knowledge of the SBAR tool, a good attitude and a willingness to put it into practice. It is essential that healthcare managers and professionals from all disciplines work together to ensure that good communication practice is developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of students and health professionals to ensure good quality standardised communication.

Communicating Standing and Walking Data after Spinal Cord Injury: A Patient-Engaged, Qualitative Study.

The Standing and Walking Assessment Tool has been implemented by physical therapists across Canada, but there is no standardized communication tool to inform inpatients living with spinal cord injury (SCI) about their standing and walking ability. To identify how inpatients with SCI are currently receiving feedback on their standing and walking ability, and to determine if and how they would like to receive information on their standing and walking. Ontario's Patient Engagement Framework informed study protocol development. Inpatients with SCI were recruited from a rehabilitation centre in Canada. Purposeful sampling considering severity of SCI and sex was adopted. Three to four months following discharge from inpatient rehabilitation, a semi-structured interview was conducted to explore participants'experiences and preferences regarding feedback on standing and walking ability during inpatient SCI rehabilitation. Interviews were audio-recorded and transcribed verbatim. A conventional content analysis was completed. Fifteen individuals with SCI (5 female, 10 male) participated. Four themes emerged from the transcripts: (1) motivation for standing and walking, (2) current standing and walking practice, (3) participant preferences for feedback on standing and walking ability, and (4) perceptions of preexisting tools. Information on standing and walking ability was shared with inpatients with SCI in a variety of ways. Participants identified various preferences for the nature, format, and frequency of feedback concerning standing and walking ability during inpatient rehabilitation, which suggests the need for an individualized approach to communicating this information.

Improving Family Communication in Critical Care

Communication with family members in critical care is challenged by socioeconomic, environmental, and organizational factors. Ineffective communication between health care providers and family members results in psychological distress and anxiety among family members and can lead to misunderstanding of the patient’s condition and ineffective decision-making. This manuscript aims to explore barriers to effective communication, understand standardized communication tools, and support their implementation in critical care. An extensive search of various databases provided a variety of articles meeting the criteria of communication barriers in critical care, end-of-life, and strategies to overcome these barriers. Health literacy, diversity, and environmental factors are significant barriers to communication in critical care. The COVID-19 pandemic has further complicated communication, necessitating organizations to implement creative communication strategies. An effective strategy that is consistently identified for improving communication is the implementation of communication skills training. The READY framework, VALUE (Value, Acknowledge, Listen, Understand, and Elicit) guide, and Psychosocial Assessment and Communication Evaluation (PACE) tool are presented as frameworks to improve communication in critical care, and important elements of family meetings are identified. The collaborative efforts of the health care team and organization are essential in overcoming the specific challenges of communicating in critical care. Health care organizations and individuals are obligated to ensure that health care providers are appropriately trained, provided adequate resources, and are competent in communicating complex information with family members. Keywords: Family communication, critical care, communication training, communication framework, communication barrier

Standardized Communication Tool Improves Inpatient-Outpatient Care Transitions for Adults with Acute Leukemia

Background: Management of adults with acute leukemia involves frequent transitions between high acuity inpatient and intensive outpatient clinical settings. While clinical handoffs between inpatient team members are well-studied, little is known about the optimal means and clinical impact of inpatient-to-outpatient handoffs. The aim of our study was to develop a standardized discharge communication tool using the electronic medical record (EMR). We hypothesized that improvement in consistent inpatient-to-outpatient handoffs at our institution would lead to improved clinical care of adults with acute leukemia. Methods: This project was performed as a quality improvement initiative at The Medical College of Wisconsin and its associated tertiary care hospital, Froedtert Hospital, between November 2020 and April 2022. Survey data was collected from inpatient and outpatient leukemia team members and was utilized to create a standardized communication tool and discharge process that was implemented in May 2021. Team members included physicians (attending, fellow, and resident physicians), advanced practice providers (APPs), and outpatient nursing and scheduling staff. The communication tool was sent by the inpatient team via EMR in-basket messaging approximately 48 hours prior to discharge. Included topics covered anticipated discharge date, types and timing of appointments needed, hospital complications, and results and tasks requiring follow-up. EMR data was collected for all discharged patients from the acute leukemia service including discharge date, follow-up appointments, and compliance with the communication tool. Patients were excluded if they were deceased prior to follow-up or discharged to hospice. 30-day readmission data was obtained from Vizient, and charts were reviewed to identify the primary reason for readmission. A follow-up survey was conducted 9 months after the tool was deployed to assess perceived changes in communication. Primary outcomes included rate of appointments scheduled prior to discharge, adherence with use of communication tool, and perceived success of the communication tool. Secondary outcomes included 30-day unplanned readmission rate and satisfaction with use of the communication tool. Significance testing was performed utilizing Chi-square testing for discrete variables and Mann-Whitney U-test for continuous variables. Results: There were 755 total discharges between November 2020 and April 2022 from the acute leukemia service: 242 (32%) in the pre-intervention group and 513 (68%) in the post-intervention group (Table 1). Compliance with use of the communication tool occurred in 70% of cases. Overall, the percentage of scheduled follow-up clinic visits remained stable between groups (89% vs. 89%), but appointments scheduled prior to discharge significantly increased from 34% to 45% (p=0.007). The percentage of total infusion visits significantly decreased in the post-intervention group (81% vs 72%, p=0.004), but there was a significant increase in those scheduled before discharge (20% vs 33%, p=0.001) (Table 1). Perceptions of communication (strongly agree + somewhat agree) significantly increased regarding timely communication, outpatient staff members being informed of clinical plans, appointments scheduled prior to discharge, and correct appointment types being made (Table 2). There was a non-significant increase in in perceived sufficient communication between teams (Table 2). The 30-day readmission rate decreased from 23% to 16% after implementation of the communication tool (p=0.017) (Table 1). The most common reasons for readmission between November 2020 and April 2022 were neutropenic fever (n=41, 29.1%) and infection not including neutropenic fever (n=21, 15%). Other reasons for readmission included respiratory complaints (n=15, 11%) gastrointestinal complaints (n=14, 10%), and neurologic complaints (n=13, 9%,). Cytopenia, oncologic reasons (treatment or transfusion reactions), and weakness/falls followed for a combined 15% (n=22). Conclusion: Implementation of a standardized discharge communication tool was associated with increased follow-up scheduled prior to discharge, perceived communication between inpatient and outpatient teams and decreased 30-day unplanned readmission rates. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Quality improvement project: Implementation of I-PASS, a structured patient hand-off tool to improve communication, increase patient safety, and prevent burnout among palliative care providers at a comprehensive cancer center.

65 Background: Communication among the health care providers plays a crucial role in team-based practices, and a standardized communication platform is essential. Our palliative care consult service (PCCS) at a university-based cancer center manages cancer-related symptoms. The handoff process among the providers takes place via encrypted emails shared among the providers. The current demand for palliative care (PC) among the cancer population led to increased patient encounters and associated handoff emails. Numerous handoff emails (sometimes up to 25-30/day) can lead to missing/overlooked information, cause burnout among the providers, and affect patient safety. Studies have shown that implementing I-PASS into clinical practices has significantly reduced medical errors without increasing documentation time. We aimed to improve communication among the PC providers, prevent burnout and increase patient safety by using a built-in I-PASS handoff tool on electronic medical records (EMR). Methods: In January 2021, we formed a team to develop a quality improvement (QI) project to implement I-PASS for our PCCS at our institution. The institutional Quality Improvement Assessment Board approved this QI project. Our team started with Plan, Do, Study, Act. After extensive brainstorming, we mapped out the Cause-and-effect diagram (Fishbone). We laid out a Process mapping through a flowchart and Feasibility impact matrix. The implementation process took place in 4 phases. Phase 1: A per-implementation survey. Phase 2: Extensive training sessions for PC clinicians, both, 1:1 and group sessions. Phase 3: October 2021 I-Pass implementation went live. Phase 4: post-implementing survey to assess provider reception. Results: Based on real-time assessment on EMR, at four months mark, we reached the 100% utilization goal for I-PASS among PC clinicians. In Pre vs. Post-implementation survey, providers perceived they could identify their patient's related information, save time, update handoff daily and locate their assignments without any efforts on I-PASS compared to email handoff (p < 0.0001). Overall, 95% of the PC providers found I-PASS helpful. Conclusions: Standardized communication tools such as I-PASS have proven safe and effective and help prevent provider burnout by improving overall workflow. Future studies need to focus on steps to continue developing tools to help modify the handoff on Smartphone EMR applications such as HAIKU.

Improving Interprofessional Collaboration Between Behavioral Mental Health and Pediatric Primary Care Providers Through Standardized Communication

Pediatric mental health crisis increases demand for integrated behavioral health and pediatric primary care providers (PPCP). Communication is key to successful integrated pediatric behavioral-mental health, but studies demonstrate gaps between existing and desired communication practices. Project aims to improve PPCP factors and patient outcomes by implementing standardized communication tool in the Electronic Health Record (EHR). Pre-post 20-week intervention. Pediatric primary care and affiliated pediatric behavioral-mental health clinic of academic health system. PBMH patients and referring PPCPs. PPCP satisfaction with communication, comfort and confidence continuing mental health care pre-post PBMH consult, and patient appointment attendance. PPCP confidence and comfort treatingmental health in primary careincreased. No significant change in PPCP satisfaction after implementing standardized communication. Identified factors associated with patient appointment continuity. Standardized EHR communication tools and enhancing PPCP confidence in managing common pediatric mental health conditions are effective collaboration strategies.

Creation of a Handoff Tool Between the Preprocedural Area and OR Team

<h3>Introduction</h3> Ineffective communication is one of the root causes of sentinel events reported to The Joint Commission. Handoff checklists are tools that assure continuity of care and promote patient safety, while allowing for questions to be asked and answered. These handoff checklists ensure proper communication and acceptance of responsibility for patient care between nurses or nursing teams. <h3>Identification of the problem</h3> The team identified a gap in communication between the preprocedural RN and the OR team. Previously, key information either verbally or through the use the EMR was the only form of communication. Ineffective handoff communication is a primary factor leading to errors. <h3>QI question/Purpose of the study</h3> The purpose of the project addresses the inconsistency in handoff between procedural RN and OR teams. The creation of a standardized communication tool reduces the risk throughout the patient's surgical process. <h3>Methods</h3> Theteam created and implemented a standardized checklist, to address the inconsistency in handoff. The new communication tool aligns with the elements corresponding with The Joint Commission Patient Safety Goals. Every patient entering the OR is subject to this process change. <h3>Outcomes/Results</h3> After implementation of the handoff checklist, items necessary for surgery and verification process are available prior to entering the OR. Use of evidence-based guidelines, included in our handoff checklist decreases preventable omissions and errors. Implementation of this handoff tool allows for greater interdepartmental communication. <h3>Discussion</h3> When our handoff tool is used consistently, communication is improved and safer outcomes are evident. The handoff tool is used throughout the entire surgical event, creating a closed loop narrative. <h3>Conclusion</h3> This communication tool has improved the process and reduced errors related to the handoff activity. Thereby, verifying the required elements and promoting patient safety. <h3>Implications for peri-anesthesia nurses and future research</h3> As a multi-building health system, it is important to work towards standardizing practices and policies ensuring consistency in patient care. Since the inception of the checklist, additional items were added to encompass the entire OR process, including handoff to PACU phase 1 and phase 2. ASPAN and AORN best practice recommended guidelines have been implemented in the version of the updated communication tool with focus on patient safety.

Implementing a Standardized Communication Tool in an Intensive Care Unit.

Effective communication is essential in critical care settings. Use of the SBAR (Situation, Background, Assessment, Recommendation) tool has been shown to standardize and improve communication among health care providers. This quality improvement project was designed to improve communication in an intensive care unit that lacked a standardized communication protocol. Communication practices differed greatly between nurses and advanced practice providers. As a result, patient safety was put at risk owing to incomplete, inaccurate, or delayed information when clinical concerns were reported or escalated. This project used a pre-post design in which surveys were used to gather information on staff perceptions of communication and collaboration between nurses and advanced practice providers before and after an educational intervention. The 2 groups received identical education on SBAR guidelines adapted for use in the intensive care unit setting and patient safety. Results showed improvement in all areas of communication. Significant improvements were found on the General Perceptions subscale among advanced practice providers (P = .04) and among nurses (P = .007). In the combined study population, improvements were observed on all subscales, with significant results for the Open Communication (P = .03) and General Perceptions (P = .002) subscales. A significant increase was found in the percentage of nurses using the SBAR tool after the intervention (95%) compared with before the intervention (66%; P < .001). Implementation of the SBAR communication tool significantly improved general perceptions of communication in this intensive care unit.

AAIM Recommendations to Improve Learner Transitions

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Communication tools and patient satisfaction: A scoping review.

ObjectiveThis scoping review aimed to present an overview of the literature on communication tools in esthetic dentistry. A variety of communication tools have been proposed to include patients in the shared decision‐making (SDM) workflow. Only little is known about implementing communication tools in dentistry and their impact on patient communication and patient satisfaction. A systematic literature search was performed in Medline, Embase, Cochrane, and World of Science to identify if communication tools have an impact on patient satisfaction.Material and MethodsThe search included studies from January 1, 2000 to March 3, 2020 published in English, focusing on patient communication tools and patient satisfaction in esthetic dentistry.ResultsOut of 6678 records, 53 full‐texts were examined. Ten studies were included. Data of the included studies were extracted systematically and subsequently analyzed. All studies found that patient communication utilizing specific communication tools positively impacted either patient satisfaction, patient‐dentist relationship, information retention, treatment acceptance, quality of care or treatment outcome.ConclusionsAdditional communication tools besides conventional verbal communication are able to enhance patient satisfaction, improve quality of care and establish a better patient‐dentist relationship. It seems essential to further develop standardized communication tools for SDM in dental medicine, which will allow the comparison of research on this topic.Clinical significanceThis scoping review shows the importance of patient involvement in the decision‐making process for improved patient satisfaction with esthetic dental treatments. With an increased implementation of communication tools, patient satisfaction and SDM may further improve in the future.

A Performance Improvement Project to Improve Hand-off Communication Documentation within the Surgical Services Department

Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary staff exposures and delays in treatment. The quality improvement nurse noticed a significant drop in the use of the standardized hand-off report form used during this time. This drop in compliance lead to concerns for patient and staff safety.

Evaluating older adults with cognitive dysfunction: A qualitative study with emergency clinicians.

Evaluating older adults with cognitive dysfunction in emergency departments (EDs) requires obtaining collateral information from sources other than the patient. Understanding the challenges emergency clinicians face in obtaining collateral information can inform development of interventions to improve geriatric emergency care and, more specifically, detection of ED delirium. The objective was to understand emergency clinicians' experiences obtaining collateral information on older adults with cognitive dysfunction, both before and during the COVID-19 pandemic. From February to May 2021, we conducted semi-structured interviews with a purposive sample of 22 emergency physicians and advanced practice providers from two urban academic hospitals and one community hospital in the Northeast United States. Interviews lasted 10-20 min and were digitally recorded and transcribed. Interview transcripts were analyzed for dominant themes using a combined deductive-inductive approach. Responses regarding experiences before and during the pandemic were compared. Five major challenges emerged regarding (1) availability of caregivers, (2) reliability of sources, (3) language barriers, (4) time constraints, and (5) incomplete transfer documentation. Participants perceived all challenges, but those relating to transfer documentation were amplified by the COVID-19 pandemic. Emergency clinicians' perspectives can inform efforts to support caregiver presence at bedside and develop standardized communication tools to improve recognition of delirium and, more broadly, geriatric emergency care.

Standardizing the Teach-Back Method for Post Procedure Discharge Instructions to Improve Patient Satisfaction

<h3>Background information</h3> The Teach-Back method is an evidence-based strategy identified as a cornerstone intervention for improving communication during patient encounters. Evidence supports that the use of this method improves understanding of discharge instructions and supports self-management in post procedure patients. The follow-up phone call data identified a need to improve patient satisfaction with discharge instructions received in the recovery room. <h3>Objective of the project</h3> The aim of the project was to implement the Teach-Back method as a standardized communication tool for providing discharge instruction in the post procedure recovery unit. <h3>Process of Implementation</h3> Nurses in the recovery room were given a pre-implementation survey on the use of and confidence in using the Teach-Back method. Education was provided for all nurses using the evidence-based IOWA toolkit, along with a PowerPoint presentation on proper Teach-Back method techniques. Post-implementation surveys were conducted after one month, three months and 20 months to monitor improvement and sustainability. Patient satisfaction data in post procedure follow-up phone calls was used to measure the outcome of the project. <h3>Statement of Successful Practice</h3> Implementing the Teach-Back method helped standardize practice and the education helped to improve staff confidence in using this method when giving discharge instructions. The data shows a 63.2% increase in staff confidence in using the Teach-Back method and 65.79 % increase in the use of teach back method, as well as, documentation of the patient's response in the electronic health record. Patient's post procedure follow-up phone call showed an increment from 92% to 100 % compliance of patient satisfaction on discharge instruction by the recovery staff post implementation. <h3>Implications of advancing the practice of peri anesthesia nursing</h3> The confidence of the staff in providing effective patient education using the Teach-Back method can have a significant impact on quality of care, patient safety, and overall patient satisfaction. Successful practice of Teach-Back method in providing post-procedure discharge instruction will help patients to fully participate in their treatments and follow-up care.

Systematic Review of Quality Improvement Projects Related to Intershift Nursing Handover.

Nursing handover is a real-time process in which patient-specific information is passed between nurses to ensure the continuity and safety of patient care. The purpose of this study was to determine the effects of quality improvement (QI) projects in improving the intershift nursing handover process. A computerized search was performed of electronic databases for articles published during 2009-2019 in English or Korean for which the full texts were available. The included studies involved QI projects, handover between nurses, and intershift handover. The QI-MQCS (Quality Improvement Minimum Quality Criteria Set) was used to appraise the quality of QI strategies. The handover methods used in the 22 QI projects could be broadly divided into 2 types: (1) using a standardized communication tool; and (2) involving patient-participation bedside handover. The published research on intershift handover-related QI projects employed standardized communication tools and the patient-participation bedside handover method to reduce adverse events and handover times and increase the satisfaction of patients and nurses. Future studies should measure the changes in patient safety-related outcomes.

Perinatal Nurses Respond to Shared Decision-Making Education: A Quasi-Experimental Study.

Women describe a loss of autonomy during childbirth as a contributing factor to labor dissatisfaction. Shared decision-making with choice, option, and decision talk may improve satisfaction. Nurses (n = 29) received education on supporting women's autonomy with a standardized communication tool (SUPPORT) to facilitate shared decision-making and create an evolving birth plan. This quasi-experimental pre-/post-test design evaluated participant responses to the education module. Participants supported the use of the SUPPORT tool for shared decision-making and developing evolving birth plans. Most recommended initiation between 13- and 26-weeks' gestation. Nurses' willingness to advocate for women's autonomy increased significantly after education (p = .022). Shared decision-making with standardized perinatal communication may support a woman's perinatal education and her satisfaction with labor.

The Journey of the Purple Butterfly: A Quality Improvement Initiative.

Dying in the hospital is not always a good experience for patients and their families. To be more in line with evidence-based practices for healthcare workers to effectively support high quality end of life care, the project team implemented a standardized communication tool to alert interdisciplinary team members of patients on comfort care measures. Purple Butterfly was a quality improvement project that was implemented at a diverse community hospital in the urban setting. Clinical and non-clinical interdisciplinary team members participated in a pre- and post- implementation survey to assess the need for a standardized communication tool that would alert them of patients who transitioned to comfort care. Pre-implementation, 37% of survey respondents (n = 60) reported they were always aware of the presence of a patient on comfort care measures prior to entering the room. After implementation of a standardized communication tool, 100% (n = 43) of respondents at 9 months, reported that they were always aware of the presence of a patient on comfort care measures prior to entering the room. Additionally, 9 months post-intervention 100% of respondents reported that knowing this contextual information supported them in performing their job duties in a compassionate, patient-centered fashion. Implementation of a standardized communication tool increased awareness for team members, about the presence of patients on comfort care measures prior to entering the room and supported team members to perform their job duties in a compassionate, patient-centered fashion supportive of this patient population.

Improving Inpatient Consult Communication Through a Standardized Tool.

To increase the number of essential consult elements (ECEs) included in initial inpatient consultation requests between pediatric residents and fellows through implementation of a novel consult communication tool. Literature review and previous needs assessment of pediatric residents and fellows were used to identify 4 specific ECEs. From February to June 2018, fellows audited verbal consult requests at a medium-sized, quaternary care children's hospital to determine the baseline percentage of ECE components within consults. A novel consult communication tool containing all ECEs was then developed by using a modified situation-background-assessment-recommendation (SBAR) format. The SBAR tool was implemented over 3 plan-do-study-act cycles. Adherence to SBAR, inclusion of ECEs, and consult question clarity were tracked via audits of consult requests. A pre- and postintervention survey of residents and fellows was used to examine perceived miscommunication and patient care errors and overall satisfaction. The median percentage of consults containing ≥3 ECEs increased from 50% preintervention to 100% postintervention with consult question clarity increasing from 52% to 92% (P < .001). Overall perception of consult miscommunication frequency decreased (52% vs 18%; P < .01), although there was no significant change in resident- or fellow-reported patient errors. SBAR maintained residents' already high consult satisfaction (96% vs 92%; P = .39) and increased fellows' consult satisfaction (51% vs 91%; P < .001). Implementation of a standardized consult communication tool resulted in increased inclusion of ECEs. Use of the tool led to greater consult question clarity, decreased perceived miscommunication, and improved overall consult satisfaction.