ABSTRACT
Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.
Subject(s)
Efficiency, Organizational , Equipment Failure/statistics & numerical data , Nursing Staff, Hospital/organization & administration , Quality Improvement , Critical Care , Cross-Sectional Studies , Humans , Medical-Surgical Nursing/organization & administration , Nurses , Nursing Staff, Hospital/education , Patient Safety , Prospective StudiesABSTRACT
Hospital communication is more than access to information. Among staff, it is about achieving situation awareness-an understanding of a patient's current condition and likely trajectory. In the multidisciplinary context of providing care, structure, consistency, and repeatability of communication will enable a shared understanding of the patient and plan, leading to improved patient satisfaction and outcomes. This was tested using the Situation-Background-Assessment-Recommendation (SBAR) protocol, a re-admissions risk assessment and daily interdisciplinary rounds (IDR) in the medical/surgical units of a hospital. The impact of these interventions on patient satisfaction, Foley catheter removal compliance, and patient re-admission rates was assessed. Over the 3 year period, Foley compliance improved from 78% to 94%, and re-admissions decreased from 14.5% to 2.1%, both significant. Patient satisfaction trended positively, but was not significant. These results support the value of SBAR and IDR, and are advocated to improve situation awareness and maintain focus on key patient data.
Subject(s)
Communication , Patient Outcome Assessment , Patient Readmission/statistics & numerical data , Teaching Rounds/methods , Adult , Awareness , Continuity of Patient Care/standards , Continuity of Patient Care/statistics & numerical data , Female , Humans , Interprofessional Relations , Male , Middle Aged , Patient Care Team , Patient Satisfaction , Teaching Rounds/standards , Urinary Catheterization/nursingABSTRACT
OBJECTIVE: To measure the impact of interdisciplinary rounds (IDRs) and the situation-background-assessment-recommendation (SBAR) communication protocol on staff situation awareness and patient outcomes. BACKGROUND: Communication frequency and consistency improve speed and clarity, especially between disciplines. Daily IDR using SBAR potentially facilitates the process. METHODS: Four patient review conditions were observed across 3 medical-surgical units of an acute care hospital: baseline, mobile (IDR only), paper-SBAR, and electronic-SBAR (IDR and SBAR). Observations occurred over a 9-month span. Review time (seconds), tools used, location, and field notes were recorded for 960 patient reviews. RESULTS: Patient review times were significantly shorter with IDR, decreasing from 102 to 69 seconds, but SBAR did not reduce times further. One patient satisfaction index did not change, whereas the other improved slightly. Length of stay did not change. CONCLUSION: The structure, consistency, and familiarity afforded by SBAR and IDR resulted in improved situation awareness and provided process, staff, and patient benefits.
Subject(s)
Communication , Outcome Assessment, Health Care , Patient Care Team/organization & administration , Adult , Continuity of Patient Care/organization & administration , Female , Humans , Interdisciplinary Communication , Male , Middle Aged , Nursing Staff, Hospital/organization & administration , Patient Handoff/organization & administration , Patient Satisfaction , Young AdultABSTRACT
BACKGROUND: Communication errors have grave consequences in health care settings. The situation-background-assessment-recommendation (SBAR) protocol has been theorized to improve communication by creating a common language between nurses and physicians in acute care situations. This practice is gaining acceptance across the health care field. However, as yet, there has been little investigation of the ways in which SBAR may have an impact on how health care professionals operate beyond the creation of a common language. PURPOSE: The purposes of the study were to explore the implementation of the SBAR protocol and investigate the potential impact of SBAR on the day-to-day experiences of nurses. METHODS: We performed a qualitative case study of 2 hospitals that were implementing the SBAR protocol. We collected data from 80 semistructured interviews with nurses, nurse manager, and physicians; observation of nursing and other hospital activities; and documents that pertained to the implementation of the SBAR protocol. Data were analyzed using a thematic approach. FINDINGS: Our analysis revealed 4 dimensions of impact that SBAR has beyond its use as a communication tool: schema formation, development of legitimacy, development of social capital, and reinforcement of dominant logics. PRACTICE IMPLICATIONS: The results indicate that SBAR may function as more than a tool to standardize communication among nurses and physicians. Rather, the findings indicate that SBAR may aid in schema development that allows rapid decision making by nurses, provide social capital and legitimacy for less-tenured nurses, and reinforce a move toward standardization in the nursing profession. Our findings further suggest that standardized protocols such as SBAR may be a cost-effective method for hospital managers and administrators to accelerate the socialization of nurses, particularly new hires.
Subject(s)
Critical Care , Interdisciplinary Communication , Nursing Staff, Hospital , Humans , Interviews as Topic , Nursing Assessment/standards , Patient SafetyABSTRACT
Nurses are increasingly called upon to engage in critical thinking. However, current workflow inhibits this goal with frequent task switching and unpredictable demands. To assess workflow's cognitive impact, nurses were observed at 2 hospitals with different patient loads and acuity levels. Workflow on a medical/surgical and pediatric oncology unit was observed, recording tasks, tools, collaborators, and locations. Nineteen nurses were observed for a total of 85.2 hours. Tasks were short with a mean duration of 62.4 and 81.6 seconds on the 2 units. More than 50% of the recorded tasks were less than 30 seconds in length. An analysis of task sequence revealed few patterns and little pairwise repetition. Performance on specific tasks differed between the 2 units, but the character of the workflow was highly similar. The nonrepetitive flow and high amount of switching indicate nurses experience a heavy cognitive load with little uninterrupted time. This implies that nurses rarely have the conditions necessary for critical thinking.
