| Description |
Background: Ineffective interprofessional communication directly contributes to medical errors, adverse patient events and the deterioration of operational relationships. A Joint Commission root cause analysis found that over 70% of all U.S. hospital sentinel events were directly related to failures in communication, resulting in billions of dollars in malpractice suits annually. A structured communication format known as Situation-Background-Assessment-Recommendation (SBAR) has long been considered the gold standard for conversations between healthcare professionals. As a call to action, the hospital system overseeing the Special Care Nursery (SCN) in the study is modifying SBAR to RSBAR: Request, Situation, Background, Assessment and Recommendation. By opening the conversation with a request, the level of urgency can be immediately conveyed from nurse to provider, streamlining communication and reducing untimely delays. RSBAR was a pilot program developed by the SCN's Intermountain West hospital system and had yet to be evaluated as a standardized communication format. The purpose of this quality improvement project was to determine the impact of the implementation of RSBAR on nurse-provider perceptions of interprofessional communication.Methods: SCN nurses and providers completed apre-implementation survey to assess the knowledge, compliance and perceived value of RSBAR, and to identify barriers to effective interprofessional communication. Education and support were provided to SCN nurses to augment implementation of the upgraded communication format. These supportive actions included pre-recorded simulation training, a case study and quiz, scripting tools, communication checklists and written excerpts in the unit staff newsletter. Participants then completed a post-survey to evaluate for changes in their perceptions of interprofessional communication quality.Results: The surveys were completed by a total of 72 participants; pre-implementation survey completion rates for staff nurses were 46% (n= 13) and increased to 61% (n= 17) for the post-implementation survey. Completion by providers remained steady at 26% (n= 21) for both pre- and post-surveys. Of the various provider roles, neonatal nurse practitioners and pediatric hospitalists represented the majority of responses. Positive changes were demonstrated by both nurse and provider groups in 42 of 43 compared survey data points and improvements in the scores and themes identified in free-text responses indicated an increase in knowledge of the components of RSBAR.Those outcome measures where statistical significance was demonstrated by both nurses (RN) and providers (P) included: compliance of RSBAR use (RN: p= .010 , P: p= <.001), perceived value of RSBAR as a tool (RN: p= .019 , P: p= .001) provider accessibility in relation to timeliness of contact and response (RN: p= .005, P: p= .016), provider actions emphasizing standards of excellence (RN: p= .038, P: p= .017), unit effectiveness in meeting patient care treatment goals (RN: p= .003, P: p= <.001) and overall nurse-provider team functioning (RN: p= .017, P: p= .002).Conclusions: Implementation of the RSBAR tool provided a succinct and consistent format for interprofessional communication in the SCN. RSBAR, accompanied by supportive nurse education and provision of tools for its use, appears to have positively impacted nurses' and providers'knowledge, compliance and perceived value of RSBAR, as well as each groups perceptions of the quality of interprofessional communication in the SCN. Replication of this quality improvement project is necessary to determine if similar degrees of improvement are noted in other populations. |
