Structured Communication Tool Research Articles

Improving communication among nursing staff at a children's hospital in the southern United States: a best practice implementation project

Introduction: Ineffective communication between health care professionals is one of the leading causes of medical errors and can result in adverse events and patient harm. Improving the effectiveness of communication in health care is a worldwide necessity. Objective: The aim of this project was to promote evidence-based practices regarding general communication principles among the nursing staff in one unit of a children's hospital in the southern United States. Methods: The project used JBI's Evidence Implementation Framework, together with two JBI audit tools (Practical Application of Clinical Evidence System and Getting Research into Practice). A baseline audit was conducted, followed by the implementation of targeted strategies. The project was completed with a follow-up audit to determine changes in practice. Results: Baseline data revealed 61% adherence with four audit criteria for effective communication in health care. Barriers included a lack of education of nursing staff regarding communication skills and less than optimal use of a structured communication tool. Targeted strategies to address the barriers included providing an educational module on communication to nursing staff and moving the structured communication tool to a more convenient location to increase its use. The post-implementation data revealed 81% adherence with the four audit criteria, a 20% increase from baseline results. Conclusions: Optimizing communication and monitoring the use of a structured communication tool has the potential to decrease the risk of medical errors among health care providers. Spanish abstract: http://links.lww.com/IJEBH/A217

Drug Errors in Obstetric Anesthesia: A Narrative Review

The subspecialty of obstetric anaesthesiology is different from other subspecialties in anaesthesiology in that, at any point of time, two lives are at stake, making drug errors particularly critical. This narrative review explores the incidence, contributing factors, and preventive strategies for medication errors in Obstetric Anaesthesia. Key contributors of medication errors include distractions, fatigue, look-alike/sound-alike drugs, lack of standardized protocols, poor communication strategies, inadequate training and education. Effective strategies for reducing errors include double-check procedures, bar-coded medication administration systems, implementing “Tall Man lettering for look-alike/sound-alike drugs, structured communication tools, continuous education and training. The review also introduces the mnemonic "SAFE-LABEL CHECK" to encapsulate best practices for minimizing drug errors. Future directions suggest integrating advanced technologies and fostering a multidisciplinary approach to enhance patient safety in obstetric anaesthesia.

Improving clinical reasoning and communication during handover: An intervention study of the BRIEF-C tool

BackgroundExisting handover communication tools often lack a clear theoretical foundation, have limited psychometric evidence, and overlook effective communication strategies for enhancing diagnostic reasoning. This oversight becomes critical as communication breakdowns...

Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center.

High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center. We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other. Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00). We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.

Learning to Communicate Together: Perspectives on an Interdisciplinary Experience Among Nursing and Physical Therapist Assistant Students

BackgroundInterprofessional communication is imperative to quality patient care and improved outcomes as well as a requirement of nursing education programs, however, gaps exist between theory and practice. Often, students are not exposed to interprofessional interactions until later in the program when simulation experiences are offered or a clinical opportunity arises. Sample29 Bachelor of Science in Nursing and three physical therapist assistant students ranging in age from 18-35 years. MethodAn interdisciplinary communication role-play simulation among second year Bachelor of Science in Nursing students and first year physical therapist assistant students was implemented utilizing a situation-background-assessment-recommendation structured communication tool to facilitate and organize their communication. ResultsA total of 15 out of 32 students reported an increase in confidence to communicate with other healthcare professionals after participation in the simulation. ConclusionThis experience provided evidence of the effectiveness of a collaborative simulated experience improving undergraduate nursing students’ understanding and confidence with interprofessional communication prior to a clinical opportunity.

Team communication improves patient safety

SBAR and TeamSTEPPS are structured communication tools that nurses should use in clinical settings to improve communication and overall patient satisfaction.

Goals, Values, and Priorities of Hospitalized Patients: Using a Structured Communication Tool to Engage Medical Students in Serious Illness Communication.

Background: To build third-year medical students' serious illness communication skills, we implemented a structured communication tool-the VALUES tool-focused on patients' goals, values, and priorities and described students' experiences using this tool. Methods: Medical students participated in a social worker-led VALUES didactic and discussion with a patient on the palliative care consult service and, subsequently, completed an anonymous survey about their comfort with the VALUES tool and its usefulness for learning (5-point Likert scales). Results: Of the 142 medical students who participated in the VALUES didactic, 37 completed the survey (26%). The VALUES tool was rated highly in terms of usefulness (mean 4.5; standard deviation [SD] 0.7) and rated lower in terms of overall comfort (mean 3.7; SD 0.7). Conclusion: Our project explored the integration of a VALUES tool into medical student education, and we show that the tool is well rated by learners in terms of comfort and usefulness.

The effects of a structured communication tool in patients with medically unexplained physical symptoms: a cluster randomized trial

Medically Unexplained Physical Symptoms (MUPS) are prevalent among primary care patients and frequently lead to diminished quality of life, increased healthcare costs, and decreased work participation. We aimed to examine the effects of a work-focused structured communication tool based on cognitive-behavioral therapy in patients with MUPS. In a Norwegian two-arm cluster randomized trial, the effectiveness of the structured communication tool Individual Challenge Inventory Tool (ICIT) was compared to usual care for patients with MUPS using a two-arm cluster randomized design. Enrollment period was between March 7 and April 1, 2022. Ten groups (clusters) of 103 General Practitioners (GPs) were randomized to provide the ICIT or usual care for 11 weeks. Patients received two or more sessions with their GP, and outcomes were assessed individually. Primary outcome was patient-reported change in function, symptoms, and quality of life measured by the Patient Global Impression of Change (PGIC). Secondary outcomes included sick leave, work-related self-efficacy (RTW-SE), health-related quality of life (RAND-36), and patient experiences with consultants (PEQ). The trial was registered on ClinicalTrials.gov (NCT05128019). A total of 541 patients with MUPS were enrolled in the study. In the intervention group 76% (n=223) showed a significant overall improvement in function, symptoms, and quality of life as measured by the PGIC, compared to 38% (n=236) in the usual care group (mean difference-0.8 ([95% CI-1.0 to-0.6]; p<0.0001). At 11 weeks, the intervention group had a 27-percentage point decrease in sick leave (from 52.0 to 25.2), compared to 4-percentage point decrease (from 49.7 to 45.7) in the usual care group. Furthermore, compared to usual care, the intervention group reported significant improvements in work-related self-efficacy, health-related quality of life, and greater satisfaction with the communication during the consultations. No adverse events were reported. The implementation of the structured communication tool ICIT in primary care significantly improved patient outcomes and reduced sick leave among patients with MUPS. The study was funded by The Norwegian Research Fund for General Practice.

Effective handovers on escalation of care for the deteriorating patient.

Evidence suggests that improvements in clinical practice are required to ensure that deteriorating patients are rapidly identified and assessed in a systematic manner. The important step of escalating care involves a detailed handover to the most appropriate colleague so that interventions can be put in place to reverse or optimise the patient's condition. However, multiple issues can hinder this handover process, including a lack of confidence among nurses and suboptimal team dynamics or cultures. Using structured communication tools such as situation, background, assessment, recommendation (SBAR) can assist nurses in delivering a handover that results in the desired outcome. This article explains the steps involved in identifying, assessing and escalating the care of deteriorating patients, and describes the components of an effective handover.

Acceptability of a Serious Illness Conversation Guide to Black Americans: Results from a focus group and oncology pilot study.

Serious illness conversations (SICs) can improve the experience and well-being of patients with advanced cancer. A structured Serious Illness Conversation Guide (SICG) has been shown to improve oncology patient outcomes but was developed and tested in a predominantly White population. To help address disparities in advanced cancer care, we aimed to assess the acceptability of the SICG among African Americans with advanced cancer and their clinicians. A two-phase study conducted in Charleston, SC, included focus groups to gather perspectives on the SICG in Black Americans and a single-arm pilot study of a revised SICG with surveys and qualitative exit interviews to evaluate patient and clinician perspectives. We used descriptive analysis of survey results and thematic analysis of qualitative data. Community-based and patient focus group participants (N = 20) reported that a simulated conversation using an adapted SICG built connection, promoted control, and fostered consideration of religious faith and family. Black patients with advanced cancer (N = 23) reported that SICG-guided conversations were acceptable, helpful, and promoted conversations with loved ones. Oncologists found conversations feasible to implement and skill-building, and also identified opportunities for training and implementation that could support meeting the needs of their patients with low health literacy. An adapted SICG includes language to assess the strength and affirm the clinician-patient relationship. An adapted structured communication tool to facilitate SIC, the SICG, appears acceptable to Black Americans with advanced cancer and seems feasible for use by oncology clinicians working with this population. Further testing in other marginalized populations may address disparities in advanced cancer care.

Comparison in perceptions and attitude towards effective communication and team collaboration among pediatric physicians and nurses following the implementation of multidisciplinary interventions

Background: Effective communication among physicians and nurses in in-patient settings is associated with better patient care1, increased teamwork, and job satisfaction2, however, no literature has addressed the concern of the gap in perception of communication between physicians and nurses.3 this study aims to explore the perceptions of physicians and nurses toward proper communication and collaboration before and after an intervention. The study period encompassed before and during the COVID-19 pandemic. Methods: A cross-sectional pilot survey was administered in September-November 2015 in pediatrics in-patient wards at Hamad Medical Corporation (Doha, Qatar) followed by a post-intervention program survey in November-December 2020. The interventions included establishing a multidisciplinary unit-based council involving physicians and nurses, and a communication skills course for physicians. The questionnaire included details of demographics, perceptions towards proper communication, and collaboration in daily clinical practice. Questions used a 3-point Likert scale. Result: 124 responses (66% physician/44% nurses) were obtained in 2015 and 83 responses (51% physician/49% nurses) in 2020. The physicians’ reported perceptions improved for nearly all survey questions, often in a statistically significant way, but it was not the case for their enjoyment of collaboration which was reduced by 10% points (p = 0.01) (Table 1). The enjoyment of collaborating with the other professions declined for the physicians (p = 0.01) whereas it improved for the nurses, but it was not statistically significant (p = 0.06). For the nurses, their perception improved across all items, but less often in a statistically significant manner. In general, nurses had higher levels of satisfaction regarding communication and team collaboration (Figure 1). Conclusions: Our study showed that physicians and nurses’ perceptions improved post-interventions. Nurses seemed to be more affected by the interventions. The biggest effect was in decision sharing as both had almost a similar improvement. Promoting communication and collaboration in a complex clinical environment is paramount. Interventions such as multidisciplinary rounds and adapting structured communication tools improve organizational culture.

Effectiveness of Incorporating Situation-Background-Assessment-Recommendation (SBAR) methods into simulation-based education for nursing students: A quasi-experimental study

BackgroundSituation-Background-Assessment-Recommendation reporting is a structured communication tool. In other studies of simulation-based education, learning was found to increase with increases in the level of flow during scenarios. Also, communication using SBAR was found to facilitate more focus on clinical situations. However, the generalizability of those findings in nursing education and the specific benefits of combining SBAR with simulation remain unclear. ObjectivesThe aims of this study are to incorporate SBAR reporting into simulation-based nurse education, and measure its effects on the students' flow, communication competence, and communication self-efficacy among nursing students, to collect basic data for the development of effective nursing curricula. DesignThis study used a non-equivalent, quasi-experimental pre-post parallel design. SettingThe intervention was administered in a simulation center at a nursing school in South Korea. ParticipantsOne hundred and twenty fourth-year nursing students were recruited through convenience sampling. MethodsThe participants were quasi-randomly allocated to the control (n = 52) and SBAR (n = 68) groups. The integrated simulation course was conducted twice each week. Learning and reporting SBAR was included as a component of simulation-based education for the intervention group in each session (three scenarios). The dependent variables were communication competence, communication self-efficacy, and flow in the simulation. ResultsSBAR did not affect communication competence or communication self-efficacy in simulation-based education. In contrast, while flow increased in both groups, the increase was greater in the SBAR group. ConclusionsSBAR can increase nursing students' flow in simulations. Further studies should focus on how SBAR during simulation-based education affects nursing students' practical competency.

Teaching Palliative Care in Surgical Education.

Without training in how to identify and relieve pain and suffering, surgeons miss opportunities to offer palliative services to patients. Despite explicit calls for expanding palliative care education since the 1990s, palliative care training in surgical curricula is often limited to end-of-life discussions. A growing consensus among palliative care experts suggests that formal palliative care education during surgical training should include structured communication and prognostication tools, strategies for symptom management, and an understanding of palliative care specialists' role in treating patients at all disease stages.

"It may help you to know…": The Early-phase Qualitative Development of a Rheumatoid Arthritis Goal Elicitation Tool.

Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making, which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians. Tool development occurred in 3 phases: (1) clinician feedback on the initial prototype during a communication training session; (2) semistructured interviews with RA patients; and (3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool. Clinicians (n = 15) and patients (n = 10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool deemphasizing goals outside of their perceived treatment domain or available resources; they highlighted the benefits of the tool to facilitate conversation but raised concerns regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and preparing for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve. A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher-quality care in RA.

The use of SBAR as a structured communication tool in the pediatric non-acute care setting: bridge or barrier for interprofessional collaboration?

ABSTRACT SBAR (Situation, Background, Assessment and Recommendation) is a structured method developed for communicating critical information that requires immediate action. In 2016 the SBAR tool was introduced at the Amalia Children’s Hospital in the Netherlands to improve communication between healthcare workers. Despite formal training and the introduction of aids to facilitate implementation, observed adherence to the tool was low. A qualitative study was undertaken to study the use of SBAR by pediatric residents and nurses in the non-acute clinical care setting of an academic children’s hospital. Semi-structured focus group sessions were conducted and qualitatively analyzed using a constructed coding template to search for facilitators and barriers in the use of SBAR by different professionals. We found professionals’ use of SBAR was influenced by departmental, cultural, and individual factors. Important themes for effective implementation and use of SBAR in an interprofessional setting, like situation dependency, learning climate and professional identity had not been addressed during the initial implementation. To facilitate SBAR’s use it is important to identify professionals’ needs to use the tool effectively, to take into account how tasks and responsibilities are perceived by different professions, and to stimulate interprofessional feedback and role modeling.

Perioperative shared decision-making in the Bay of Plenty, New Zealand: Audit results from a complex decision pathway quality improvement initiative using a structured communication tool.

Patients presenting for elective surgery in the Bay of Plenty area in New Zealand are increasingly elderly with significant medical comorbidities. For these patients the risk-benefit balance of undergoing surgery can be complex. We recognised the need for a robust shared decision-making pathway within our perioperative medicine service. We describe the setup of a complex decision pathway within our district health board and report on the audit data from our first 49 patients. The complex decision pathway encourages surgeons to identify high-risk patients who will benefit from shared decision-making, manages input from multiple specialists as needed with excellent communication between those specialists, and provides a patient-centred approach to decision-making using a structured communication tool.

SBAR as a Standardized Communication Tool for Medical Laboratory Science Students.

Laboratory professionals must communicate effectively on an interprofessional team. It is the responsibility of Medical Laboratory Science (MLS) programs to teach communication. The structured communication tool Situation, Background, Assessment, and Recommendation (SBAR) is one way to promote effective communication. Students participated in a case-based simulation activity on the importance of teamwork/communication and the use of SBAR and completed a pre/post survey on communicating interprofessionally. Students reported increased confidence and competence with interprofessional communication after the activity with 4 of 5 questions demonstrating a statistically significant increase in scores post SBAR instruction. Our study demonstrates that SBAR is a suitable communication tool that can be used to increase our MLS students' confidence and competency in interprofessional communication. Educators should use this communication tool to empower MLS students to be effective members of the healthcare team.

Use of the Serious Illness Conversation Guide to Improve Communication with Surrogates of Critically Ill Patients. A Pilot Study.

Background: International family-centered critical care guidelines recommend formal, structured communication to ensure that clinical decision making is informed by a shared understanding of diagnosis and prognosis and patient goals and preferences. Tools to facilitate these recommendations are limited.Objective: To examine the feasibility, acceptability, and utility of a standardized serious illness conversation (SIC) to guide communication between nonpalliative care trained providers and surrogates of critically ill, mechanically ventilated patients.Methods: After providers received training, including simulation, we implemented SIC in October 2018. A total of 11 hospitalist providers were eligible to perform SICs over the study interval. Providers met in person with surrogates of adult, mechanically ventilated patients in the medical intensive care unit within 48 hours of intubation. To determine acceptability, surrogates were surveyed 2 months after SIC completion, and providers were surveyed between June and July 2018. To determine feasibility and utility, two independent investigators reviewed SIC documentation and coded responses into categories.Results: Of 72 eligible patients, advanced care planning documentation was completed in 50 patients, including 36 SICs, for an advance care planning completion rate of 69% and an SIC completion rate of 50%. The average SIC was completed in 30 minutes, 3 days after intubation. Of the 19 surrogates surveyed, 95% found the SIC to be mostly or extremely worthwhile. Nine of 11 hospitalist providers completed the follow-up survey. Each of the nine providers who completed the survey found the guide valuable to patient care and easy to administer. The conversation yielded valuable information in terms of goals, fears, and worries; sources of strength; abilities critical to the patient; and understanding how much the patient would be willing to go through for the possibility of gaining more time.Conclusion: We found that implementation of a structured communication tool in the intensive care unit was feasible and acceptable to surrogates and providers; yet, fidelity to the timing and completion was modest. The tool appeared to yield valuable information for understanding the goals, fears, and care preferences of mechanically ventilated patients. Steps to increase fidelity, in accordance with family-centered care guidelines, are warranted.

Development of the NEC-Zero Toolkit: Supporting Reliable Implementation of Necrotizing Enterocolitis Prevention and Recognition.

The goal of the NEC-Zero project is to reduce the burden of necrotizing enterocolitis (NEC) by increasing access to evidence-based tools to help clinicians and parents integrate evidence into daily care. It involves (a) human milk feeding with prioritized mother's own milk; (b) use of a unit-adopted standardized feeding protocol; (c) a unit-adopted strategy for timely recognition that integrates risk awareness and a structured communication tool when symptoms develop; and (d) stewardship of empiric antibiotics and avoidance of antacids. A toolkit for caregivers and parents was developed to make implementation consistent. For clinicians the toolkit includes: the GutCheckNEC risk score, a structured communication tool, the "Avoiding NEC" checklist, and the NEC-Zero website. For parents, NEC-Zero tools include the website, three educational brochures in English and Spanish, and a collaborative care video produced with the NEC Society. This article describes the toolkit and how it has been accessed and used.

Improving the quality of handover: implementing SBAR.

Effective communication is essential in the provision of safe patient care. Use of structured communication tools, such as the Situation, Background, Assessment and Recommendation (SBAR) format of handover have been shown to improve patient safety, especially for telephonic handovers.1 SBAR has widely been recommended as a standardised method of handover.2,3 We undertook a quality improvement (QI) project to increase SBAR awareness across two wards in a district general hospital. This study describes the effect of our interventions and the challenges of implementing QI methodology to measuring safe communication and handover.