Use of High-Fidelity Simulation to Enhance Interdisciplinary Collaboration and Reduce Patient Falls.

OBJECTIVES: This pilot study aimed to determine the effect of nurse/physician interdisciplinary team training on patient falls. Specifically, we evaluated team training in a simulation center as a method for targeting and minimizing breakdowns in perceptions of respect, collaboration, communication, and role misunderstanding behaviors between care disciplines. METHODS: Registered nurses (RNs) were randomly assigned to participate. Residents were divided into groups and assigned based on their availability and clinical responsibility. All participants completed a demographic form, the Professional Practice Environment Assessment Scale (PPEAS), and the Mayo High Performance Teamwork Scale (MHPTS) after consenting and before participation in simulation training. The PPEAS and the MHPTS were readministered at 2 and 6 months after the simulation experience. Differences in MHPTS and PPEAS scores between the baseline and 2- and 6-month assessments were analyzed; fall rates over time were evaluated using Cochran-Armitage trend tests. RESULTS: After the team training exercises, teamwork as measured by the MHPTS improved significantly at both 2 and 6 months (P = 0.01; P < 0.001) compared with baseline measurement. Practice environment subscores, with the exception of positive organizational characteristics, also increased when measured 6 months after training. The primary outcome, reduction in anticipated patient falls, improved significantly (P = 0.02) over the course of the study. CONCLUSIONS: Results of this pilot study show that team training exercises result in improvement in both patient safety (anticipated patient falls) and team member perception of their work environment. If validated by other studies, improvement in this patient safety metric would represent an important benefit of simulation and team training.

Surfacing and addressing hospitalized patients' needs: Proactive nurse rounding as a tool.

AIMS: This paper reports on rounding interventions employed at high performing hospitals, and provides three case studies on how proactive nurse rounding was successfully implemented to improve patient-centredness. BACKGROUND: Proactive nurse rounding is a popular form of rounding that has shown promise for improving patient outcomes, yet, little evidence exists on how to implement it successfully. METHODS: We identified high-performing hospitals in the domains of staff responsiveness and nurse communications in the Hospital Consumer Assessment of Health Providers and Systems survey nationally, and conducted case studies at three of these hospitals exploring their implementation of proactive nurse rounding. We partnered with leaders from these hospitals to describe the associated challenges and lessons learned. RESULTS: Twenty-six high performing hospitals in the domains of staff responsiveness and/or nurse communication were identified. The majority of nursing units reported proactive nurse rounding as their main rounding intervention (96%). CONCLUSIONS: Proactive rounding interventions are a feasible approach to help surface and address hospitalized patients' needs in a timely manner. IMPLICATIONS FOR NURSING MANAGEMENT: The information and tools provided in this paper build upon the learning from high performing hospitals' experiences and are useful to nurse leaders in their efforts to improve the patient-centeredness in the hospital.

Using high-fidelity simulation to develop nurse-physician teams.

BACKGROUND: This study was undertaken to determine whether interdisciplinary high-fidelity simulation training improves group cohesion in nurse-physician teams. In addition, perceptions of collaboration and satisfaction with patient care decisions were measured in nurse-physician participants. METHODS: Clinical scenarios relevant to the general surgical urology inpatient unit were conducted in an interdisciplinary high-fidelity simulation center. Participants included physicians and staff nurses. RESULTS: Participants reported a positive shift in group cohesion over time. In addition, the results suggested a positive shift in perceptions of collaboration and satisfaction with patient care decisions over time. The youngest participants (Millennial Generation, born in the 1980s and 1990s) showed the most significant growth in response to the training. CONCLUSION: This study provides evidence of benefits of high-fidelity simulation that extend beyond the training. Simulation training may be a strategy to build and strengthen relationships across nurse-physician teams. In addition, this type of training may positively affect collaboration and satisfaction with patient care decisions. When data were analyzed by generational grouping, the most significant growth occurred in the Millennial Generation participants. These influences need to be explored further.