Not Always as Advertised: Crew’s Clues

Project Topic:

Improving the intake and dispatch process

Hospital, City and State:

Nemours Children’s Hospital, Wilmington, Delaware

Unit:

Pediatric Critical Care Transport Team

CSI Participants:

• Sandra Glenn-Vernon, BSN, MS, RN, CCRN, PHRN
• T. Dawn Jackson, BSN, RN, PHRN
• Meghan Monaco, BSN, RN
• Donna Dixon, BSN, RN, PHRN

Project Goals/Objectives:

1. Improve Critical Care Transport Team (CCTT) Healthy Work Environment Assessment Tool (HWEAT) Skilled Communication Score
2. Improve CCTT HWEAT True Collaboration Score
3. Initiate a formal debrief process
4. Develop a standardized process for CCTT intake and dispatch
5. Improve team engagement and overall satisfaction
6. Improve positive patient outcomes

Project Outcomes:

1. Improved HWEAT aggregate score and 5 standard scores with authentic leadership score remaining the same
2. Increased HWEAT Skilled Communication score from 3.61 to 3.74
3. Increased HWEAT True Collaboration score from 3.50 to 3.63
4. Decreased the number of incidents of patient presentations that differ from initial intake call 67%
5. Developed a formalized debrief process by June 1, 2024.
6. The team participated in a formalized debrief process for 49% of transports and 91% after redosing the project

Project Overview:

The Healthy Work Environment Assessment Tool (HWEAT) revealed deficits in Skilled Communication and True Collaboration. Effective communication during the intake and dispatch of interfacility transports is essential in ensuring optimal outcomes for the CCTT and for the patients and families we serve. The project was an opportunity to optimize communication involving the intake and dispatch process. Improving skilled communication and collaboration will improve interprofessional communications, team dynamics, the dispatch process, handoff reports, bedside times, and patient outcomes.

In November of 2023, the CSI team launched the HWEAT. The survey results confirmed deficiencies in Skilled Communication and True Collaboration on our CCTT. We identified that the greatest area of impact to improve skilled communication was through our intake and dispatch process.

The CSI team began the project by creating a survey to assess the CCTT staff’s satisfaction with the current communication process. This led to the development of our new Debrief Tool. The debriefing tool allowed each team member an opportunity to discuss alternatives, clarify questions, identify missing information, and request a Total Process and Quality (TPQ) discussion for improvement initiatives. The CSI participants planned a kickoff party to encourage team engagement with a goal of 80% participation in the initiative.

In April of 2024, our Debrief Tool questionnaires went live. The debrief completion rate was low until September 2024, when we intensified participation by developing a friendly game of Puppy Bowl football between our day shift and night shift staff. We utilized our creativity by employing our manager as a referee, charge nurses as quarterbacks, our CSI leader as the coach, and yes, we even had a water boy. Every team member was represented and held accountable to progress down the field of play without a flag or a turnover in our new process with hopes of earning a touchdown. A pizza party and sweet treats were provided to the winners of each game. We completed four games and elevated our debrief completion rate to 97%. On the sidelines, our CSI participants were diligently tracking the details of every patient call through the Debrief Tool. All the information was gathered daily and manually entered into databases created by the CSI improvement team participants. Debrief statistics were consistently recorded and posted every month. In recognition, any teammate identified as a most valuable player modeling their commitment to true collaboration and skilled communication was honored on the Puppy Bowl Wall of Fame.

The project feedback received from participants and managers has been rewarding. We not only achieved all our goals, but we had unintended positive outcomes. We gained more insight into the importance of team configurations, situational awareness, and respect for colleagues in overcoming difficult patient care challenges. Patients received more efficient care due to team preparedness and interprofessional teams were respectfully more inclusive. In addition, our CIS team received an acceptance to present a poster at NTI.