It’s the Little Things That Matter: Improving Collaboration Between RNs and Physicians in the NICU

Project Topic:

Improving collaboration between RNs and physicians during rounds in the NICU

Hospital, City and State:

Los Angeles General Medical Center, Los Angeles, California

Unit:

Neonatal Intensive Care Unit (NICU)

CSI Participants:

• Eunnie Choe, BSN, RN
• Lara Frerking, ADN, RN

Project Goals/Objectives:

1. Increase Healthy Work Environment (HWEAT) scores for True Collaboration standard 15%
2. Improve collaboration between RNs and physicians
3. Standardize rounding
4. Increase RN attendance and involvement in bedside NICU rounds
5. Improve team cohesiveness
6. Improve patient outcomes

Project Outcomes:

1. Increased HWEAT scores for True Collaboration standard by 33%
2. Increased HWEAT scores for all standards and aggregate score
3. Implemented board rounds to provide more structure and ensure better collaboration to help treat patients safely and effectively
4. Educated 97% of staff about project
5. Increased RN attendance during NICU rounds from 67% to 92%
6. Unable to quantify a fiscal impact for this project

Project Overview:

In 2023, we sent out the HWEAT survey to our colleagues. The survey results indicated True Collaboration was our lowest score. We decided to focus on improving collaboration between RNs and physicians during bedside NICU rounds to improve team cohesiveness and patient outcomes. The CSI team chose this project because we know that teamwork is essential to providing the highest quality of care for our NICU patients. Our shared goal is to ensure that each infant in our care benefits from the collective expertise and dedication of the entire team.

We educated 97% of our staff during our project kickoff and worked closely with both RNs and physicians to implement our plan. We initiated board rounds and since we have physician-led rounds, we reminded the physicians to ensure nurses were at the bedside to participate in rounds and to summarize any plan changes at the end of each round, so both teams were aware of the plan changes. To track RN attendance, we created an audit tool for both RNs and physicians to complete in the first few weeks of project initiation. RN attendance during NICU rounds increased from 67% to 92%. By the end of the project, our HWEAT True Collaboration score increased 33%, and scores for the other five standards also increased.