Improving Communication, Efficacy and Safety Between Emergency and Imaging

Project Topic:

Improving communication, efficacy and safety between Emergency and Imaging

Hospital, City and State:

Sturdy Memorial Hospital, Attleboro, Massachusetts

Unit:

• Emergency Department (ED)

CSI Participants:

• Haylee Foley, BSN, RN
• Courtney Holske, BSN, RN
• Patrick Nichols, ADN, RN
• Kristen Rotondo, BSN, RN

Project Goals/Objectives:

1. Implement a new process for ED to imaging transport
2. Decrease the number of people involved in communication handoffs to prevent errors
3. Decrease delays in care
4. Decrease safety events related to transportation 50%
5. Decrease Oldenburg Burnout Inventory score 10%
6. Increase HWEAT True Collaboration score 5%
7. Increase HWEAT Skilled Communication score 5%

Project Outcomes:

1. Decreased safety events related to transportation 100%
2. Decreased the number of patients who left without being seen from 603 to 439.
3. Decreased Oldenburg Burnout Inventory score 8.1%
4. Increased HWEAT True Collaboration score 5.1%
5. Increased HWEAT Skilled Communication score 3.9%
6. Improved interdepartmental relationship between ED and Imaging
7. Established microblog access for all nursing staff
8. These outcomes resulted in a positive estimated annual fiscal impact of $690,476.

Project Overview:

Transportation from the ED to imaging was complex, inefficient and unsafe. ED patients must complete their scans in a safe, efficient and timely manner. Test results are crucial to determining a patient’s diagnosis, plan of care and disposition. Before the start of this project, frustration between ED staff and the imaging department was at an all-time high. There was no way for imaging to directly communicate with nursing staff and all messages were being filtered through the unit coordinators. In addition, there was not a dedicated transport team for the emergency department to utilize, so all transports to and from imaging became a shared task between the imaging department, the nurse and the ED technicians. Ultimately, there were a lot of people involved in transportation communication handoffs and safety events became a problem. In an effort to increase patient safety during transportation, streamline communication and decrease delays in care, we implemented a change project.

During our project kickoff, we launched a new transportation workflow and eliminated non-clinical staff (unit coordinators) from the process. We educated staff on how to update their phone extensions at the start of each shift in the electronic charting system and created tracking board access for all imaging departments. The tracking board allows imaging to identify the nurse caring for each patient and view their phone extension in real time. We eliminated the paper ticket to ride, which solved potential HIPAA (Health Insurance and Portability and Accountability Act) concerns. Furthermore, we established microblog access for all nurses so that another form of direct communication between disciplines is available. Microblog access is being utilized regularly by nurses to communicate with hospitalists regarding admitted patients, which has been crucial during our busy boarding season.

Overall, the feedback about our project’s interventions has been positive. Being able to know exactly who to directly communicate with has improved teamwork and decreased frustration between departments. Although communication has vastly improved, challenges still exist with not having a dedicated transport team to bring patients to imaging. Conversations with upper management regarding this issue are ongoing and we have just been approved to utilize the hospital’s transport team for a trial basis.