Stop, Communicate and Listen

Project Topic

Improving nurse-to-nurse and nurse-to-provider communication

Hospital Unit

Cardiac Intensive Care Unit (CICU)

CSI Participants

Christine Ellis, RN, CCRN
Tamara Macilroy, RN, BSN, CCRN

Project Goals/Objectives

1. Improve communication and teamwork between day- and night-shift nurses as measured by satisfaction survey
2. Increase collaboration between nurses and providers as measured by satisfaction survey
3. Decrease central line and urinary catheter days 5%
4. Decrease nurse overtime 5%
5. Increase and sustain provider satisfaction from baseline 20%
6. Increase nurse utilization compliance with a standardized care plan note and rounding tool to 75%

Project Outcomes

1. Increased nurse satisfaction 89%
2. Decreased end-of-shift overtime 22% resulting in a projected savings of $40,108 per year
3. Increased provider satisfaction 60%
4. Achieved more than 95% nurse utilization compliance with the standardized care plan note, with over 90% accuracy
5. These outcomes resulted in an estimated annual fiscal impact of $40,108.

Project Overview

Our CSI team decided to tackle communication as our project based on a desire to improve patient safety and nurse overtime, and to address a lack of provider and nurse satisfaction with our current rounding tool and care plan note. Creating a standardized care plan note that included rounding tool information gave us the opportunity to positively impact communication in our Cardiac ICU.

Our electronic health record allowed us to create a smartphrase for use by all nurses in our unit as a template for their care plan note. The smartphrase automatically pulls data deemed important by our provider group directly into the note, saving nurses time and frustration. Nurses no longer have to search the chart at the end of a 12 hour shift for provider-requested information, e.g. when the central line was placed or the patient’s 24-hour temperature maximum ― it is automatically inserted in the note.

The overall impact of the smartphrase has been impressive. Our sister ICU adopted the approach very quickly so that our provider group has consistency with both units. Our patients are safer because the improved communication tool helps us ensure we are not missing information or wasting time on redundancy by bringing data about the patient into one location.

In 2020 our patient population changed due to preparations for the COVID-19 surge. The number of cardiac surgeries decreased and we began admitting medical ICU patients, who often have a greater ICU length of stay. This shift interfered with efforts to reduce central line and urinary catheter days. However, we did not experience any increase in central line-associated bloodstream infections (CLABSI) or catheter-associated urinary tract infections (CAUTI).

During the initial COVID-19 surge, our focus on data was temporarily sidelined given the changes with patient acuity and census. We later evaluated data from before and after our project launch more closely and found a 22% decrease in incremental overtime. Our CSI team believes the smartphrase we developed enabled nurses to get through their charting more efficiently, contributing to the reduction in overtime. The estimated fiscal impact of this decrease is $40,108 annually.

Our CSI team has expanded our project to our hospital’s Medical ICU. They changed the format slightly, but it reflects the same information as the Cardiac ICU note. Other units have reached out for information about our the process to create their own smartphrase. We presented our project at a system-wide virtual conference and additional nurses have expressed interest in the project. Our provider has group shared their desire to take our standardized care plan note to the other Providence hospitals where they practice.

Our CSI team is sustaining the project by including the note as part of new hire orientation. We are currently working on a way to use this tool as our shift report.