This study evaluates the impact of using a standardized worksheet on physican and nurse perceptions of understanding of the goals of care. The effect of this intervention on intensive care unit (ICU) length of stay (LOS) was also assessed.
This study was conducted in a 16-bed Medical ICU at Beth Israel Medical Center, a large urban teaching hospital. The worksheet lists daily goals, is completed on morning rounds, and is posted at the bedside. The worksheet is comprised of sections to record information regarding tests/procedures, medications, sedation, analgesia, lines and catheters, consultations, nutrition, mobilization, family discussion and consents, and disposition. Attendings, residents and nurses were given a questionnaire before and six weeks after implementation of the worksheet. Responses to evaluate understanding were scored on a 5-point scale (1=understand nothing, 5=understand completely). Quantitative variables were analyzed using a t-test and qualitative variables using chi-square.
For the three months since this worksheet was used, ICU LOS averaged 4.44 days, compared with an average LOS of 6.26 days over the same three months one year earlier.
Use of a daily worksheet during daily multidisciplinary ICU rounds led to improved perception of nurses’ understanding of the goals of care and communication with physicians. For physicians, the only significant changes were improved understanding of daily tasks and improved communication with nurses. Physicians and nurses expressed a desire to continue using these worksheets. Use of the worksheet was associated with a 29% reduction in ICU LOS.
Use of a simple communication tool on daily Medical ICU rounds can lead to improved nurse-physician communication and satisfaction and may be associated with reduced LOS. Before Worksheet6 Weeks after WorksheetP valueNursesUnderstand goals of care (mean score)3.954.830.001Understand tasks (mean score)4.434.670.28Understand plans for transfer (mean score)4.094.330.35Nurse-physician communication (mean score)3.574.250.03Would you like to use a daily worksheet?15/21 (71%)13/14 (93%)0.02PhysiciansUnderstand goals of care (mean score)4.584.900.03Understand tasks (mean score)4.755.000.08Understand plans for transfer (mean score)4.424.470.08Nurse-physician communication (mean score)3.424.700.01Would you like to use a daily worksheet?12/12 (100%)9/14 (64%)0.07
M. Narasimhan, None.