Streamlining Communication and Improving Collaboration Among Units For Heart Transplants

Project Topic:

Improve True Collaboration and Skilled Communication amongst four nursing units by creating a streamlined process for communication for peri-procedural coordination regarding heart transplant patients

Hospital, City and State:

Beth Israel Deaconess Medical Center, Boston, Massachusetts

Units:

• Cardiac Cath Lab
• Heart Transplant
• Cardiac Access
• Holding Area

CSI Participants:

• Lydia Gallup Fletcher, MS, RN
• Christine Lyons, BSN, RN
• Lindsay McCoo, BSN, RN
• Coach: Christina Jewell, MSN, RN

Project Goals/Objectives:

1. Increase Healthy Work Environment Assessment Tool (HWEAT) True Collaboration score to 4.0 or greater
2. Increase HWEAT Skilled Communication score to 4.0 or greater
3. Create clear guidelines for communication between access nurses, transplant team, cath lab, and holding area nurses – have 75% compliance for communication pathway
4. Increase the number of Advanced Heart Failure (AHF) providers performing right heart catheterization + biopies (RHC/EMBx) to 75%
5. Increase utilization of electronic health record FYI flags to 100%

Project Outcomes:

1. Increased HWEAT True Collaboration score from 3.37 to 4.21
2. Increased HWEAT Skilled Communication score from 3.61 to 4.28
3. Communication pathway implemented with 100% compliance
4. Increased use of AHF providers performing RHC/EMBx to 62% of all cases
5. All heart transplant patients have FYI flags in EHR

Project Overview:

Beth Israel Deaconess Medical Center implemented a new heart transplant program in 2023. With that implementation came challenges of growing any new program. One such challenge was coordinating post-transplant right heart catheterization and biopsy (RHC/EMBx). The coordination of these procedures involves four nursing care areas: Heart Transplant, Cardiac Access, Cardiac Cath Lab, and Holding Area. In an effort to streamline the coordination process, the team gathered data from the HWEAT survey sent to the respective teams to determine where to focus. The results demonstrated that True Collaboration and Skilled Communication were areas that needed improvement.

After identifying areas needing improvement, the team developed a tool called “Communication Pathway,” which was an algorithm to be used amongst the four nursing units. The communication pathway tool was implemented so that all nurses working in these designated areas had a clear guideline on who to contact should certain events occur.

Additionally, the team met with advanced heart failure providers (AHF) to discuss the efficiency of utilizing AHF providers for RHC/EMBx procedures. This discussion allowed the providers to “buy-in” to our project, which included increased use of AHF providers rather than relying on the interventional cardiology physicians.

Further, the team implemented a plan of using another communication tool within the electronic health record (EHR). The EHR's FYI flag is easily seen, accessible to all nurses, and can be used to assist in communication between areas. The FYI Flag includes RHC/EMBx access site (IJ vs Femoral) and sedation plan (no sedation vs. sedation). This allowed all staff to identify those patients needing the use of the holding area and those who do not.

After implementing those changes, a repeat HWEAT survey was conducted, and the fiscal impact was measured on the procedural holding area to measure the effectiveness of the interventions. The post-clinical HWEAT survey data showed that HWEAT scores increased to > 4.0. Further, the total number of cases, types of cases, and costs related to these cases, comparing pre and post implementation data, showed that the project provided a total fiscal impact of $48,534.

The feedback from our peers regarding the project’s interventions has been positive. Colleagues reported an improvement in the process of care coordination and in identifying who to notify regarding changes to any procedural plans. To sustain the success of the project, the team plans to continue to engage colleagues in dialogue regarding what they find helpful versus what makes little difference in their coordination of procedures.