Novel use of communication technology to improve nurse-physician communication, teamwork, and care coordination during bedside rounds^*

* This manuscript is not under review elsewhere and there is no prior publication of manuscript contents. The preliminary results of this manuscript were presented at the Society of General Internal Medicine National Meeting, Hollywood, Florida in May 2016. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

ABSTRACT

Background: Inter-professional bedside rounding has been used to reduce communication deficits and improve patient outcomes. Our objective was to evaluate nurse and physician participation in inter-professional bedside rounds and perceptions of communication, teamwork, and care coordination, through a quality improvement (QI) intervention.

Method: A web-based survey was completed by attending and resident physicians and nurses working on the general medical wards of an academic-affiliated Veteran’s Health Administration Hospital (VHA). Responses were assessed using the chi-square statistic. Qualitative responses were grouped into themes for analysis to guide the intervention. A pre-existing electronic communication device was utilized in a novel way by resident physicians to facilitate nursing participation in bedside rounds. Perceptions of communication, teamwork, and care coordination between nurses and physicians prior to and after introduction of the electronic communication device were assessed. Direct observation was used to assess nursing presence during physician team rounds.

Results: Following the intervention, both nurses and physicians agreed more nurses were alerted by physicians when rounds began and better communication between nurses and physicians occurred. However, technological barriers limited sustainability. Nursing presence on rounds increased from a baseline of 16.5% to 36% post-intervention.

Conclusions: Implementation of a voice-activated, communication device on rounds facilitated improvement in perceptions of communication, teamwork, and care coordination, which may ultimately impact cultural change and patient outcomes.

KEYWORDS:

• Teamwork
• inter-professional communication
• care coordination
• technology
• hospital medicine

Ethical approval

This study was approved by the institutional review at University of Iowa and the Iowa City VHA Healthcare System Research and Development Committee: IRB #201507852.

Disclosure statement

No potential conflict of interest was reported by the authors.

Acknowledgements

The work reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, VA Chief Resident in Quality and Safety Fellowship Program, VA Quality Scholars Fellowship Program, and the Health Services Research and Development (HSR&D) Service through the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center (REA 09-220).

Notes on contributors

Alexis Wickersham, MD is a Clinical Instructor and Hospitalist in the Department of Internal Medicine at the Sidney Kimmel Medial College at Thomas Jefferson University.

Krista Johnson, MD is a Clinical Associate Professor of Internal Medicine at the University of Iowa Carver College of Medicine and Educational Director for Safety and Quality of the Internal Medicine Residency Program.

Aparna Kamath, MBBS, MS is an Assistant Professor of Internal Medicine at the Duke University School of Medicine.

Peter J. Kaboli, MD, MS is a Professor of Internal Medicine at the University of Iowa Carver College of Medicine and the Vice Chair of VA Affairs for the Department of Internal Medicine.

ORCID

Alexis Wickersham http://orcid.org/0000-0001-9981-2700

Notes

* This manuscript is not under review elsewhere and there is no prior publication of manuscript contents. The preliminary results of this manuscript were presented at the Society of General Internal Medicine National Meeting, Hollywood, Florida in May 2016. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.