Improved communications transform UW Medical Center heart failure teams

Improved communications transform UW Medical Center heart failure teams

The heart failure teams at UW Medicine treat more than 600 patients annually, severely ill individuals whose lives rely on the coordinated efforts of highly trained, cross-disciplinary healthcare professionals. Care is provided by two teams, one for the cardiac intensive care unit (CCU) and another for the telemetry unit (5NE).

Yet 70 percent of preventable medical errors occur because of miscommunications and poor teamwork, and are shown to be the third leading cause of death in the U.S.

That is where the UW Center for Health Sciences Interprofessional Education, Research and Practice (CHSIE) comes into the picture. Funded with $1.3 million in federal grants from the Health Resources & Services Administration, CHSIE and UW Medicine developed an academic-practice partnership focused on improving patient safety and care by enhancing team communications and functioning.

NEXUS award recipients

The CHSIE team was selected this summer to receive the 2017 NEXUS Award.

So successful were their efforts that CHSIE was selected this summer to receive the 2017 NEXUS Award, presented by the National Center for Interprofessional Practice and Education at a national event in Minneapolis. The highly competitive award is given annually to organizations that make outstanding contributions to transform healthcare delivery and improve outcomes.

The interprofessional collaboration grew out of several existing programs, including an educational model known as TeamCORE administered by WWAMI Institute for Simulation in Healthcare (WISH) for the states that it serves (Washington, Wyoming, Alaska, Montana and Idaho) and TeamSTEPPS, which provides training around teamwork and communications.

“The University is one of seven regional training centers for TeamSTEPPS,” said Dr. Brenda Zierler, CHSIE co-director, project lead and professor in the School of Nursing. “We took this team training and turned it into a structured process focused on improving patient safety and care.”

To move the project from classroom to practice, Zierler had to find a healthcare unit willing to partner. The CCU team led by Dr. Kevin O’Brien seemed an ideal match.

“Over a four-year period prior to grant funding, our heart failure teams had decreased patient lengths of stay, improved mortality rates and cut costs,” O’Brien said. “But at the same time, we saw challenges around communications and teamwork. We welcomed the chance to work with Brenda and her team to improve our approach.”

Inpatient heart failure care at UW Medicine employs about a dozen cardiologists, more than 100 nurses, some 14 advanced practice providers and many other healthcare professionals, such as social workers, pharmacists and physical therapists. “These individuals need to work together smoothly to insure the best patient care,” Zierler said, “but we saw problems with poor hand-offs and interpersonal conflicts.”

Over a three-year period, CHSIE held 17 leadership workshops and trained 329 individuals on improving work processes, promoting communications and building partnerships across disciplines. “No one is trained to understand another person’s role or scope of practice,” Zierler said. “It takes time to build trust and foster a team that can collaborate and communicate effectively.”

In a baseline survey, team communication and relationships were assessed and results shared back to the heart failure teams. They were asked: How can you improve communication and relationships among your team and how can you improve your day-to-day performance in terms of patient care and safety? Conducting patient rounds as a team surfaced as a project goal.

To inform the process, detailed scripts to improve bedside interactions were drafted and simulations run. Every point was nailed down—from who should talk first during rounds to which team member asks the family if they have questions. The process was rolled out first for the CCU team and then for the telemetry unit.

A consistent two-hour slot for rounds was established, making it easier for patients and families to know when the care team was going to be meeting to discuss the plan for the day as well as be available for questions.  A whiteboard in each room prominently displays the plan of care, and a new patient handout explains the rounding process and the roles of each team member.

The approach is a hit for patients, who appreciate the more personal contact. “I feel like the more eyes on me, the better,” said a patient that wished to remain anonymous. “It means more people looking for issues.”

Two years after launch, nurse participation in patient rounds has increased from 21 percent to more than 75 percent. When all team members hear the same information at the same time, rounds are more efficient and nurses are paging doctors less often to ask follow-up questions. In addition, the team survey has been repeated each year and has continued to show improvements in team communication and relationships.

“The nurses love this new way of doing rounds,” O’Brien said. “It’s more empowering. We saw a dramatic improvement in job satisfaction and the degree to which the nurses feel valued. We’ve also seen big improvements in staff and patient satisfaction, with ratings for both units now among the highest at UW Medical Center.”

To make sure the project continues beyond the grant cycle and can be scaled up across the University health system, the CHSIE team is developing a toolkit. Videos and scripts dealing with bedside rounds, along with survey tools and training materials, will be available online soon.