Education, Research, and Quality Improvement: Education and Quality Improvement |

Rounding and Communication Bundle in Medical Intensive Care Unit: A Quality Improvement Initiative: Identification of Barriers FREE TO VIEW

Khalid Sherani, MD; Aashir Shah, MD; Apurwa Karki, MD; Kelly Cervellione, MSPH; Howard Rosen, MBA; Mahendra Patel, MD
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Jamaica Hospital Medical Center, Jamaica, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A238. doi:10.1016/j.chest.2016.02.247
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SESSION TITLE: Education and Quality Improvement

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Current Society of Critical Care Medicine (SCCM) guidelines state that implementation of “Care and Communication Bundle” in Intensive Care Units (ICU) reduces conflicts in the goals of care and improves overall patient and family satisfaction. We identified that there was no such bundle in place in our medical intensive care unit (MICU) leading to patient and family dissatisfaction. We initiated this quality improvement project with the following objectives: 1) To identify the potential barriers for effective communication with the patients and their families 2) To identify the potential barriers for effective communication within the team members in RCU 3) To design an intervention to overcome the identified barriers 4) To evaluate the impact of these interventions

METHODS: Two strategies, Define-Measure-Analyze-Improve-Control (DMAIC) and Plan-Do-Study-Act (PDSA), were used to identify the potential barriers and design an implementable intervention. Baseline outcome variables were obtained for a 3-month period through survey and review of electronic medical records.

RESULTS: During the pre-intervention phase, only 16% of the patients with MICU length of stay greater than 2 weeks had care conferences within first two weeks of their stay. Only 25% of the patients as well as staff members were satisfied with communication practices used. Using DMAIC the system issues identified were- 1) Inability of the patients and their families to understand the physicians 2) Lack of communication between different team members in the RCU 3) Inconsistent messages being delivered to the patients 4) Inconsistent rounding times

CONCLUSIONS: The baseline data points support our observation that in the absence of any organized bundle, the patients are not satisfied with the level of communication practices used. It re-enforces the need to develop and implement a “Rounding and Communication Bundle” in MICU. Structured care conferences, organized multidisciplinary rounding and change in rounding times can be some of the key components of this bundle. Implementation of such a bundle in MICU is a simple yet effective way to improve patient and staff satisfaction.

CLINICAL IMPLICATIONS: Once developed and placed in practice, such a bundle can serve as an important tool to improve communication and patient satisfaction.

DISCLOSURE: The following authors have nothing to disclose: Khalid Sherani, Aashir Shah, Apurwa Karki, Kelly Cervellione, Howard Rosen, Mahendra Patel

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