Targeted interventions improve shared agreement of daily goals in the pediatric intensive care unit.

OBJECTIVE

To improve communication during daily rounds using sequential interventions.

DESIGN

Prospective cohort study.

SETTING

Multidisciplinary pediatric intensive care unit in a university hospital.

SUBJECTS

The multidisciplinary rounding team in the pediatric intensive care unit, including attending physicians, physician trainees, and nurses.

INTERVENTIONS

Daily rounds on 736 patients were observed over a 9-month period. Sequential interventions were timed 8-12 wks apart: 1) implementing a new resident daily progress note format; 2) creating a performance improvement "dashboard"; and 3) documenting patients' daily goals on bedside whiteboards.

MEASUREMENTS AND MAIN RESULTS

After all interventions, team agreement with the attending physician's stated daily goals increased from 56.9% to 82.7% (p < .0001). Mean agreement increased for each provider category: 65.2% to 88.8% for fellows (p < .0001), 55.0% to 83.8% for residents (p < .0001), and 54.1% to 77.4% for nurses (p < .0001). In addition, significant improvements were noted in provider behaviors after interventions. Barriers to communication (bedside nurse multitasking during rounds, interruptions during patient presentations, and group disassociation) were reduced, and the use of communication facilitators (review of the prior day's goals, inclusion of bedside nurse input, and order read-back) increased. The percentage of providers reporting being "very satisfied" or "satisfied" with rounds increased from 42.6% to 78.3% (p < .0001).

CONCLUSIONS

Shared agreement of patients' daily goals among key healthcare providers can be increased through process-oriented interventions. Improved agreement will potentially lead to improved quality of patient care and reduced medical errors.