Let’s Grow Together: Collaborating for Better Outcomes

Project Topic:

CCU/VICU-Let's Grow Together: Collaborating for Better Outcomes

Hospital, City and State:

Virginia Mason Franciscan Health St. Anthony Hospital and Virtual Hospital, Gig Harbor, Washington and Tacoma, Washington

Unit:

Critical Care Unit (CCU) and Virtual Intensive Care Unit (VICU)

CSI Participants:

• Elise Bacon, BSN, RN
• Cheryl Birkeland, BSN, RN, CCRN
• Elizabeth Bohn, BSN, RN, CCRN
• Emily Calder, BSN, RN

Project Goals/Objectives:

1. Improve communication and collaboration between departments
2. Reinforce communication standards:
   • SBAR: situation, background, assessment, recommendation
   • 3 R's: readback/recap, response time, rationale
3. Improve AACN Healthy Work Environment Assessment Tool (HWEAT) standards of True Collaboration and Skilled Communication scores for both units to 4.5
4. Improve our aggregate positive scores to 75% on question 1 for both units and question 8 for SAH CCU on the Virginia Mason Franciscan Health St. Anthony Hospital and Virtual ICU SAH/VICU Feedback Form
5. Decrease SAH RN 7-month turnover rate average to 15.09%
6. Maintain VICU RN 7-month turnover rate average at 6.25%
7. Decrease mean days on ventilator to 4.08 from 4.48

Project Outcomes:

1. Increased HWEAT aggregate score for SAH from 4.49 to 4.56
2. Increased HWEAT SAH True Collaboration standard score from 4.23 to 4.32
3. Decreased HWEAT SAH Skilled Communication standard score from 4.34 to 4.29
4. Increased all other HWEAT standard score for SAH
5. Decreased all HWEAT standard scores for VICU
6. Decreased SAH RN turnover from 10 to 7 nurses
7. Increased VICU nurse turnover from 1 to 3
8. Decreased SAH patient mean days on ventilator from 4.48 to 4.07
9. These outcomes resulted in a positive estimated annual fiscal impact of $772,206

Project Overview:

Our hospital organization has a unique collaborative structure: virtual care teams. Care teams at the bedside in the hospital are supported by a team of virtual providers and nurses who provide remote monitoring assistance for the care of sick patients. This dynamic presents its own set of challenges, particularly in the field of skilled communication and true collaboration. Our teams have experienced breakdowns in communication in this virtual environment over the years, leading to poor teamwork and adverse patient events.

The CSI team began our project with the goal of enhancing our teamwork and improving patient outcomes. We found that closed-loop communication, as well as the rationale provided for dismissed requests, was lacking. We brought it back to the basics by setting communication standards and expectations for both teams. We implemented educational interventions and tested change over the course of a year leading to increased teamwork satisfaction between both bedside and virtual care providers.