Featured Guest Contributor

A High-Return Investment in Communications

By: Nancy J Lee, RN, MSN, NEA-BC
Chief Nursing Officer, Vice President for Patient Care Services

Nothing is more important for patient safety than effective communication among all members of the care team. Yet under the fast pace and time pressures that physicians and nurses experience, making better communication a priority can be very challenging. When we take on the challenge to improve communication for increased safety, we also improve other critical aspects of our operations, resulting in a win/win outcome for patients, caregivers and SHC.

This is what we have learned over the past year by making communications a focus of the Committee on Professionalism. This collaborative group is chaired by Dr. Joe Hopkins, senior director for medical quality, and includes physician and patient care leaders from both Stanford Hospital & Clinics and Lucile Packard Children's Hospital. As one of its members, I see the significant progress we are making and how far we still have to go.  

One of our most successful initiatives at SHC has been launching Team Care Rounds to ensure that all members of a patient's care team have a daily opportunity for direct communication with each other. Participants include a patient provider (who may be a physician or nurse practitioner) and a resource nurse, as well as representatives from nutrition, pharmacy, social work and other areas as appropriate. While the idea of adding a meeting may initially seem like more time pressure, it has been shown that regular face-to-face communication with everyone present actually increases efficiency.

Over an 18-month period, we have achieved 85 percent participation by a patient provider in these rounds, an indication that physicians are experiencing real benefit. When the sender and receiver of messages on a patient care team communicate directly, they each have the right information and the right goal to guide their decisions and actions. Not surprisingly, that leads to improved coordination of care, which then produces additional benefits.

During this same period, we saw length of stay actually decrease. Giving everyone on the patient care team a better understanding of when discharge is expected prepares them to get everything necessary for discharge done on time and reduces delays. Recognizing that there is even more that can be accomplished in this area, we launched the Estimated Date of Discharge Project. Among its innovations is that the projected timing of discharge is written on a white board in the patient's room, providing not only the patient and family with this important information, but making it visible to members of the care team each time they enter the room.

Imagine how it feels to a patient when a nurse has to ask, "What did the doctor tell you?" instead of already knowing what the physician has said. Not surprisingly, better communication and coordination by the care team also leads to increased patient satisfaction. Our scores are beginning to reflect this and patients are telling us that something is different.

Time is the most precious commodity for everyone involved in patient care. While it may seem counter-intuitive that adding communication processes and systems actually gives valuable time back to physicians and nurses, we are demonstrating that it does.

When combined with the invaluable benefits of improving safety, enhancing coordinated care, reducing length of stay and increasing patient satisfaction, improving communication among members of the care team is among the highest return investments we can make.

SHC Nursing is committed to continuing our support of these important efforts. I welcome the opportunity to work with medical staff leadership to keep us moving forward and I invite any of you who have feedback or ideas to contact me directly.