ABSTRACT
Background: Good communication with patients and families is important for older adults admitted to acute stroke or geriatric medicine wards, particularly with COVID19-related restricted visiting. These patients often have communication difficulties including aphasia, delirium, cognitive or hearing impairment, limiting their own communication with relatives. Using the Plan, Do, Study, Act (PDSA) approach we undertook a quality improvement project to optimise communication with families of patients on above wards in a large tertiary hospital. Methods: PDSA cycle 1: Staff were surveyed to identify satisfaction level with communication and ways to optimise communication. Inpatients on study wards were identified, we recorded demographic and clinical details and prevalence of communication difficulties. We created a designated folder with individual 'communication sheets' in conjunction with ward doctors and the nurse manager. PDSA cycle 2: We performed a rapid interval audit of the communication folder use. 'Outlier' patients were excluded as their teams did not receive education about folder use. Results: PDSA cycle 1: A total of 90 inpatients on three wards were included, mean age 78y (SD ±14.4y), 47% were male. Three-quarters (73%) had a communication difficulty noted, reported by nursing staff. Two patients were intubated and six had stroke-related aphasia. Half of surveyed staff reported communication with families was suboptimal. Most (86%) suggested a centrally-located communication logbook would be helpful. PDSA cycle 2: Over two weeks, communication sheets were reviewed for all included patients. Median frequency of calls to families was 4 days (range 0- 14). Most (79%) had the name of the primary contact clearly documented. Many (52%) included no contact number. Only 9% had secondary contact information documented. Conclusion: Communication with families of patients on acute stroke and geriatric medicine wards was suboptimal. Over a short interval this improved with regular phone calls using specific centrally-located communication folders. Further optimisation of their use is needed.
ABSTRACT
Introduction: The COVID-19 pandemic increased the volume of critically ill patients in hospital. Healthcare professionals (HCPs), many of whom had limited experience of communicating bad news to relatives, needed to be able to do this and often by telephone. Aim: To design, deliver and evaluate a simulation based course to help HCPs communicate about death and dying by telephone during the pandemic. Methods: In March 2020 a multi-professional group of clinicians and educators developed a 2-hour, socially distanced communication skills course for HCPs in our Trust. Courses ran through March-June 2020, each course facilitated by 3-5 faculty. The course taught the 'SPIKES' structure for breaking bad news (BBN), using it to critique a pre-recorded conversation and role play of simulated scenarios, with faculty feedback. Participant confidence (using 1-5 scale) was assessed by pre and post course questionnaire, and analysed by descriptive statistics. Qualitative feedback was from participant questionnaires and thematic analysis of a faculty focus group. Ethical approval was gained. Results: 79 HCPs attended a course;55 gave feedback: nurses (24), doctors (21), allied health professionals (10). There was significant improvement in participant confidence in having a communication structure for BBN (mean change 1.69 (CI 1.94,1.44), p=0.03);applying SPIKES to BBN by telephone (mean change 1.82 (CI 2.05,1.59), p=0.005);giving and seeking feedback to improve communication (mean change 1.55 (CI 1.79,1.3), p=0.012). Qualitative data indicated excellent engagement and relevance beyond the pandemic. A faculty focus group identified key themes: applicability post COVID-19, greater openness to communication challenges, and awareness of emotionality in practice. Conclusion: An innovative course developed during the COVID-19 pandemic demonstrated improved HCP confidence in communicating bad news. Skills taught are applicable post pandemic and will inform further course development.