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Education, Teaching, and Quality Improvement |

Geographic Distribution of Patients in the Medical Intensive Care Unit (MICU): A Low-Cost Strategic Organizational Initiative to Improve Communication, Education, and Employee Satisfaction

Jonathan Wiesen, MD; Rafid Fadul, MD; Joseph Khabbaza, MD; James Middleton, RN; Jorge Guzman, MD
Author and Funding Information

Cleveland Clinic Foundation, Cleveland, OH


Chest. 2013;144(4_MeetingAbstracts):557A. doi:10.1378/chest.1703515
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Abstract

SESSION TITLE: Outcomes/Quality Control Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: High acuity centers struggle to preserve open communication between nurses and primary teams in the medical intensive care unit (MICU) in the face of increasing patient volumes. Compounding the complexity of this issue, reimbursements are tied to performance metrics such as communication scores and patient experience. Heretofore, patient care teams were assigned by chronologic rotation of admissions, independent of location. This study examines the impact of geographically aligned patient care teams on perceived communication, education and employee satisfaction.

METHODS: Surveys were distributed to pulmonary and critical care fellows, nurses and respiratory therapists (RT) before and two months after the switch to a geographic system to assess their impressions of team communication, delivery of care, education and overall satisfaction. Employee engagement surveys and HCAHPS scores were reviewed as well.

RESULTS: Although there were no differences in the communication of nurses and RT with patient’s families and consultants after the switch to geographic distribution, many more nurses (71 vs. 34) and RT (25 vs. 2) reported improved communication with the primary team (p<0.001). Overall satisfaction with the MICU experience improved as well after the geographic distribution of patients was implemented (67 vs. 44 nurses, 25 vs. 2 RT, p<0.001). Fellows similarly felt that the geographic distribution allowed them to monitor patients more closely (20 vs. 5), respond more quickly to crashing patients during rounds (20 vs. 8), communicate more effectively with nurses (19 vs. 6) and patient families (17 vs. 10), and optimize time for education (12 vs. 3, for all p<0.001). Satisfaction among fellows was improved with the geographic distribution of patients as well (p<0.001).

CONCLUSIONS: Geographic patient distribution significantly improved the morale of both fellows and nurses, and was thought to improve communication with all vital members of the clinical team. Education in the MICU was thought to be enhanced as well.

CLINICAL IMPLICATIONS: Improved communication within a multidisciplinary team is important to enhance patient experiences and outcomes. The study demonstrates the benefit of low-cost strategic organizational initiatives. Opportunities for future research exist in correlating value-based purchasing metrics with non-clinical initiatives to improve patient care, experience and cost.

DISCLOSURE: The following authors have nothing to disclose: Jonathan Wiesen, Rafid Fadul, Joseph Khabbaza, James Middleton, Jorge Guzman

No Product/Research Disclosure Information


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