Reliable Teams Communicate Reliably: The I.N.U.P Process (U of U Health)
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Incremental improvements, like introducing team members to a patient, can have a big impact on a patient’s experience. Neurologist Pete Hannon shares how his team has improved communication to earn trust and confidence.
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Reliable Teams Communicate Reliably: The I.N.U.P Process (U of U Health)
- 1. Communication Builds Trust Pete Hannon, MD Neurology
- 2. Being in the hospital
- 3. Being in the hospital • Often due to devastating illness or injury • Loss of control: day-to-day, management of illness • Loss of privacy • Potential for invasive, uncomfortable or even painful procedures • You may meet a multitude of providers throughout your stay • Profound decisions and care entrusted to a team of individuals you’ve never met • ‘Best case’ may be pressure-filled, emotional, high stakes situation • You want a team you can trust, that you feel is qualified
- 4. Miscommunication • Provider/Patient trust is needed most during complex or critical medical management • Miscommunication, or a lack of communication, erodes trust • Loss of confidence in care team • Anger, confusion, frustration, fear • Potential for Team/Patient confrontation/discord • What if something unexpected happens? • ‘Resiliency’ built through trust is missing…
- 5. Neurology: MD Communication • Early on, it was clear we had some work to do with MD communication on our inpatient service • HCAHPS not at goal • Running into issues with patients frustrated with lack of communication of results and care plan • Having issues getting care team players ‘on the same page’
- 6. Inspiration
- 7. E-Checklist
- 8. E-Checklist • Not rounding with nursing consistently • We were rounding with Pharmacy consistently • Plan was ‘discussed’ ~70% of the time • Team would perform better when ‘watched’ (Hawthorne effect) • Some attendings resented being ‘watched’ • Checklist fatigue inevitably set in
- 9. Miscommunication: themes • Who’s my ‘main’ provider? • Why won’t someone tell me my test results? • Why do I hear one thing from one team/provider and something different from another? • What’s the plan???
- 11. Introductions
- 12. Nursing Present
- 13. Update Plan
- 14. PM Rounds
- 15. Results 70.9 75.0 80.0 80.4 82.8 82.5 85.7 82.1 91.5 79.1 90.2 82.4 80.7 83.3 83.9 85.4 88.9 60.0 65.0 70.0 75.0 80.0 85.0 90.0 95.0 100.0 May '17 Jun '17 Jul '17 Aug '17 Sept '17 Oct '17 Nov '17 Dec '17 Jan '18 Feb '18 Mar '18 Apr '18 May '18 Jun '18 Jul '18 Aug '18 Sept '18 %Always NAC - Likelihood to Recommend % Always
- 16. Lessons learned: Vision • Change is challenging: people don’t inherently want to change! • Explain the problem clearly: why is this relevant? • Keep the message/intervention simple: don’t overburden the system • Small changes can actually make significant differences if they directly address breakdowns in care
- 17. Lessons learned: The Team • The sum of the parts far exceeds the whole • Having nursing & pharmacy present during rounds has improved care • A cohesive clinical team makes work more enjoyable/rewarding • One of the primary reasons I wanted to train/work here • Strong collaborators are essential • Susan Clark, Dana Dewitt and team
- 18. Lessons learned: Motivation • Go after ‘low hanging fruit’ early can build momentum • Incremental positive results can increase buy-in • Share feedback with the team • If you can’t be clear about what impact you are having, then no one will see the reason for ongoing change • Value projects can be rewarding! • Small projects can be sometimes be implemented relatively easily • Results of efforts can be evident quickly
- 19. NAC Monthly Quality Meeting https://www.meistertask.com/blog/better-brainstorm-inclusive-team-meetings/
- 20. NAC Monthly Quality Meeting • Susan Clark, Nurse Manager • Ann Gardner, Clinical Nurse Coordinator • Elizabeth Moody, Nurse Educator • PT/OT/ST • Pharmacy • ARUP • Michael Lowe, Quality Consultant • James Neider, EEG Nurse Manager • Erin Ekstrom, Stroke Center • Neurology: Dana DeWitt, Pete Hannon • Neurosurgery: Sarah Manacho
- 21. NAC Monthly Quality Meeting • Started 4 years ago • Multidisciplinary team tasked with: • Improving patient care and communication • Monitoring falls, adverse outcomes • Monitoring medication errors • Monitoring patient education • Keep specific internal metrics
- 22. To learn more, visit: https://uofuhealth.utah.edu/accelerate/ © U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 8
Editor's Notes
- Pete Hannon Neurologist with focus in Stroke, Inpatient care, Medical Education and Quality Improvement Today I’m going to talk about steps we took to improve patient communication on our Neurology inpatient service & and lessons we learned along the way
- -Imagine for a second that you yourself, or a loved one is in the hospital for a serious medical condition
- The truth is, being in the hospital can be an inherently awful experience
- Way back in 2013 we drew inspiration from work that our own Bob Pendelton and his colleagues were doing with a 7point paper checklist to improve rounding consistency and patient safety
- -We developed an electronic version that would upload directly to a RedCap database -Our checklist was longer, 10-12 items, and residents or students would check it off as we went through each patient encounter -We implemented the list on 3 occasions, with some updates as we went along -Success was a mixed bag, In terms of effectiveness,
- When it came down to it, and we distilled down what we had learned with the e-checklist and our internal patient surveys—we came up with 4 areas that we really wanted to focus on that we felt would have the biggest impact on patient communication
- Hello, I am P__________, and I am the Neurologist in charge of your care Introduce whole team, each day if needed Face sheet provided to patients, which are added to as team change, and will be provided to patients at time of discharge so they have a record of providers that took care of them
- Having the nursing and pharmacy present allows for everyone to review the plan together with the patient, and family if present Not having to chase each other down later in the day Helps alleviate Pt dissatisfaction on the ‘front line’ directed towards nurses Decisions are made as group allows for immediate changes or modifications as needed to the plan
- A simple action to keep the plan on the patient’s white-board updated planned diagnostics/treatments for the day as well as therapy and dispo goals
- -Every day, a provider on the team is responsible for rounding again on each patient prior to the team leaving -Residents round on their own patients for straightforward updated -Complicated discussions or family meetings are staffed by the attending or senior residents as warranted
- Benson Sederholm
- Communication is also critical among team members
- Pain reassessment, Advanced directives CAUTI, CLABSI Falls Call light response time Stroke education and care plans Hand hygiene Bedside report/BCMA Scanning HCAHPS
- Communication!