| Description |
The Thoracic Intensive Care Unit (TICU) at Intermountain Medical Center cares for critically ill patients who are suffering from a variety of cardiac, pulmonary, and vascular ailments. These individuals have multiple comorbidities, which potentiates the need for complex care and attention delivered by a multidisciplinary staff of professionals. The TICU has a small group of critical-care medical doctors (CCMDs) caring for the patients who do not follow the expected surgical care course, which warrants intensive medical management; these specialized clinicians consult and treat at the bedside. Care is provided around the clock, but most often takes place during daytime hours. Communication throughout the night between the nurses and CCMDs is limited to urgent/emergent patient needs only (drastic change in neurological, cardiac, or pulmonary status), and takes place via telephone. Many nonurgent issues are left to be passed on from one nurse to another during the shift change. Barriers in communication during shift change have been shown to cause accidental omissions of information, which can result in longer hospital stays, decreased patient satisfaction, and increased medical costs if not addressed in a timely manner. Miscommunication has been shown to be one of the major reported factors related to sentinel events in health care. Preventable deaths due to error in trauma patients with otherwise survivable injuries account for up to 10% of fatalities in level-I trauma centers, 50% of which occur in the ICU. Root-cause analyses, as reported by the Joint Commission, have revealed that 67% of sentinel events are due to communication error. This DNP (doctor of nursing practice) scholarly project was conducted to investigate current communication patterns in the TICU, synthesize and identify themes and patterns in communication, and provide recommendations to help improve communication and patient care in the TICU. A survey was designed based on an extensive literature review, constructed in REDCap, and delivered to all nursing staff and CCMDs in the TICU. Survey results showed that based on a Likert scale rating from 1-5, communication was felt to be 40% very effective by the nursing staff and 50% effective by the CCMDs. The majority of communications between the hours of 1700 and 0700 took place over the telephone and were believed to have been of an urgent nature; nurses felt that 87% of calls were at a minimum rating of urgent, and CCMDs felt that 100% of calls received were rated at urgent or higher. Nonurgent issues such as activity, diet, medication orders, and maintenance intravenous fluids were identified as needing clarification that would not warrant a phone call to the CCMDs during the night; these were left to be communicated verbally from one nurse to another during shift change report. Barriers to communication were highly responsible for delaying needed attention for these issues, allowing them to evolve to more urgent status. The TICU would benefit from a written communication tool that is not part of the patient's chart but will alert the CCMDs of these nonurgent issues. Addressing these matters during the nonurgent stage would escalate the quality of care provided and increase satisfaction for all parties involved. |
