Decreasing Burnout and Turnover in Traumatic Brain Injury Rehabilitation

Project Topic:

Decreasing Burnout and Turnover

Hospital, City and State:

Spaulding Rehabilitation Hospital, Charlestown/Cambridge, Boston, MA

Unit:

• Traumatic Brain Injury Rehabilitation

CSI Participants:

• Sonam Dickey, ADN, RN
• Simona Spinelli, BSN, RN
• Madison LeBaron, BSN, RN
• Gregory Iaccarino, BSN, RN

Project Goals/Objectives:

1. Decrease Oldenburg Burnout Inventory Score (OLBI) 10%
2. Decrease staff turnover rates 37.5% or 0.6 nurses
3. Increase AACN Healthy Work Environment Assessment Tool (HWEAT) True Collaboration Score

Project Outcomes:

1. Decreased OLBI total score from 39.61 to 36.71 (7%)
2. Increased HWEAT aggregate score from 3.79 to 4.38 and all HWEAT standards
3. Increase HWEAT True Collaboration score from 3.28 to 3.87
4. Increased collaboration between sister hospitals
5. Cambridge created a space for a break room to have space away from unit noise
6. Increased awareness of noise on unit and the effects it has on staff and patients
7. Decrease in fall rates due to project interventions

Project Overview:

This project focused on reducing staff burnout caused by alarm fatigue, which contributes to desensitization, delayed responses to critical events, and patient safety risks. Initial assessment included analysis of alarm data, alarm types, and staff feedback to better understand the scope of the problem. Based on these findings, multiple interventions were implemented, including revising telemetry necessity assessments, establishing a “no pass” rule for all alarms, implementing break buddy coverage to ensure uninterrupted 30-minute breaks, and enhancing staff education, particularly on recognizing and managing brain injury storming. Additional strategies included creating safety PODs for high-risk patients and developing unit-specific resources.

The first intervention was reducing unnecessary alarms by collaborating with providers to reassess continuous monitoring needs, especially for stable chronic patients. A revised policy supporting 24–48 hours of monitoring before discontinuation helped minimize non-actionable alarms. Overall, the project aimed to decrease alarm burden, improve staff well-being, reduce turnover, and maintain high standards of patient safety.

The second intervention was named “No Pass Rule” for all staff required to respond to any alarm they hear by entering the room and checking the safety of the patients, regardless of their assignment. This intervention assured accountability, reduced the length of alarm ringing, and so reducing triggering noises, while maintaining and reinforcing the safety of patients.

The third intervention was the “Break Buddy Rule,” which ensures safe coverage during staff breaks by requiring nurses and professional care assistants to give their work phones to a designated colleague and also to notify the charge nurse of going to the 30-minute lunch break. This intervention assured that the assigned buddy will maintain continuity of care for all patients during those 30 minutes, responding to alarms during that time and guaranteeing patient safety.

We applied two distinct interventions across the two locations. At Spaulding Charlestown a safety pod was already implemented, but had limited resources to share with nursing staff for when to advocate for a patient to be placed on the pod or to be removed from the POD. An information flyer was created to fill this gap in knowledge and assist with new hire orientation.

At Spaulding Cambridge we started focused education for the new nurses about patients with Disorder of Consciousness (DOC), emphasizing early recognition of “storming” symptoms such as tachycardia, hypertension, diaphoresis, posturing, agitation and their management. The goals of this education are to provide a timely response for maintaining the safety of the DOC patients and at the same time, reducing alarm activation