Kochis Michael A, Franko Lynze R, Swierzewski Kathleen, Parmar Alison, Algeri Suzanne, Gartland Rajshri M
Massachusetts General Hospital Department of Surgery, Boston, Massachusetts, USA
Massachusetts General Hospital Department of Surgery, Boston, Massachusetts, USA.
BMJ Open Qual. 2025 May 6;14(2):e002995. doi: 10.1136/bmjoq-2024-002995.
Suboptimal interprofessional communication in the surgical inpatient setting has important implications for patient safety. Our departmental quality committee identified numerous safety events resulting from discordant expectations between surgical floor nurses and surgical residents or advanced practice providers (APPs) who serve as responding clinicians (RCs), and from reluctance to escalate clinical concerns. Alphanumeric paging is frequently used to communicate, but there are opportunities to enhance its effectiveness. This initiative sought to improve perceptions of communication and responsiveness between nurses and RCs by providing a shared language and set of expectations about the urgency of pages, appropriate responses and the process of escalation to other team members if necessary.
An interprofessional team of surgical faculty, nurses and residents solicited input from surgical floor nurses, operating room nurses, residents, APPs and attendings on their perceptions of communication barriers among team members via online surveys and focus groups. Guidelines were iteratively developed. They specify that every page should be classified as STAT, Urgent, Please Call or FYI. Each classification is associated with an expected response time and pathway for contacting alternative team members if no response is received. After 3 months of implementation on our hospital's two main general surgery units, follow-up online surveys with multiple-choice and free-response questions assessed perceived impacts on communication and clinical care. Differences in categorical variables were assessed with χ tests, and free text was analysed inductively.
After implementation, nurses reported favourable effects on communication, including significantly improved responsiveness during night shifts and timeliness from RCs during day shifts. Residents and attendings perceived the intervention to have overall neutral to mildly positive effects on communication.
Paging and Escalation Guidelines are a feasible approach to enhance the perceptions of communication between nurses and RCs by aligning expectations, streamlining responses and decreasing barriers to escalation.
外科住院患者环境中专业间沟通欠佳对患者安全具有重要影响。我们科室的质量委员会发现，外科病房护士与担任响应临床医生（RC）的外科住院医师或高级实践提供者（APP）之间期望不一致，以及不愿上报临床问题导致了众多安全事件。字母数字传呼经常用于沟通，但仍有提高其有效性的空间。本倡议旨在通过提供关于传呼紧急程度、适当回应以及必要时向其他团队成员上报流程的共同语言和一套期望，来改善护士与RC之间的沟通和响应认知。
一个由外科教员、护士和住院医师组成的跨专业团队，通过在线调查和焦点小组，征求外科病房护士、手术室护士、住院医师、APP和主治医生对团队成员之间沟通障碍的看法。指南经过反复制定。指南规定，每条传呼应分为紧急（STAT）、加急、请致电或仅供参考（FYI）。每个分类都与预期响应时间以及在未收到响应时联系其他团队成员的途径相关联。在我院两个主要普通外科病房实施3个月后，通过带有多项选择题和自由回答问题的后续在线调查，评估对沟通和临床护理的感知影响。分类变量的差异用卡方检验进行评估，自由文本进行归纳分析。
实施后，护士报告沟通有积极效果，包括夜班期间响应性显著改善，白班期间RC的及时性提高。住院医师和主治医生认为该干预对沟通总体有中性到轻度积极的影响。
传呼和上报指南是一种可行的方法，通过统一期望、简化回应并减少上报障碍，来提高护士与RC之间的沟通认知。
