We Need To Talk: Getting Acute Care Teams On The Same Page
When asked her top priority for Patient #4, the hospital nurse caring for her stated that keeping the patient in bed would be best. And the doctor’s orders? “Get her out of bed.”
Patient #4 was one of many in a study published by the Agency for Healthcare Quality and Research (AHQR) highlighting differing priorities for patient care among providers in acute settings. Study findings showed that only 17% of the time was there full agreement between the team. All too often, conflicting opinions of healthcare professionals, even within the same facility, can get in the way of effective patient care.
During a typical four-day stay in a hospital, patients may encounter more than 50 hospital employees that all need to be on the same page about not only care plans, but also care delivery details. Yet, more than 20% of patients experience conflicting information, care teams that do not know who is in charge of patient care, and other hospital system inefficiencies.
Communication—especially effective communication—among care teams is the key to giving patients the best and most appropriate care in acute settings. Unfortunately, poor communication between providers is one of the top contributors to medical errors and patient harm.
These breakdowns in communication between acute care professionals can be attributed to a variety of organizational and structural issues. With a steady flow of patients in and out of a facility, acute care teams frequently move from bedside to bedside, making efficient and effective communication between them a challenge. And, they often see patients at different times than their colleagues and receive different information to inform their care opinions. Additionally, patients who bounce from facility to facility bring a crowd of provider opinions, making it difficult to reconcile both internal and external directions.
To address these challenges and facilitate better communication, the Denver Health Medical Center implemented a comprehensive internal communication strategy to help acute care teams get on the same page. The facility used a standardized questionnaire, Situation, Background, Assessment Review (SBAR), to base each conversation off of that concluded by asking each member of the care team: “What do I think needs to be done for the patient?”
From there, teams conducted quick, mandatory huddles each day or shift to speak with each other directly—not just read notes. This allowed the teams to set, and adjust, the priorities of care for their patients with each new day’s challenges and opportunities. Additionally, the hospital established multidisciplinary rounds that brought the care team together with the patient at once to ensure that everyone was on the same page.
While achieving alignment among acute care team members should be a celebrated achievement, teams also need to ensure that they are aligning on the right direction. Hospitals usually involve a patient’s primary care provider (PCP) for the big-picture care plan, but PCPs have the opportunity to be proactive and facilitate the communication of even the smallest details.
This level of collaboration with PCPs can help address the acute care miscommunications and disagreements, and help ensure that patients get the safest and most appropriate care treatments. After all, it’s the PCPs who have the familiarity with the patient and knowledge of their history to settle care plan discrepancies, such as whether Patient #4 should stay in or get out of bed.
Interested in how else you can collaborate with PCPs and get all members of the acute care team on the same page?