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Communication of critical information following implementation of a standardized format for multidisciplinary rounds on labor and delivery
Abstract Number: T-38
Abstract Type: Original Research
Introduction: Communication errors are involved in 85% of hospital sentinel events; however, multidisciplinary rounds using various cognitive aids (i.e. checklists, flowsheets) have been shown to reduce errors in a variety of hospital settings (1-3). We hypothesized that developing and incorporating a standardized 6-item checklist into nurse-led multidisciplinary rounds on labor and delivery would result in more frequent communication of critical information.
Methods: A six-item checklist was developed using Delphi methodology with a multidisciplinary group of anesthesiologists, obstetricians, and nurses. (Table) Nurse educators and leaders were engaged through face to face meetings and agreed to educate and implement the new format. Implementation included posters, laminated cards, emails and in-person reminders from nurse leaders to use the new format. The 6-item format for rounds was incorporated into RN workflow by placing the new format on their SBAR sheet. A total of 28 multidisciplinary rounds were recorded, 14 pre-implementation (PRE) and 14 post-implementation (POST). Audiotapes were transcribed verbatim. Two reviewers, blinded to timing (PRE vs POST), evaluated the number of critical items addressed during each patient’s discussion. Inter-rater reliability was determined using Cronbach’s alpha. Fisher’s exact and Mann-Whitney U tests were used for analysis.
Results: A total of 133 patients were discussed in the PRE period and 83 discussed in The POST period. Reviewer agreement was 0.84. Median number of checklist items addressed were not different between PRE (2 (IQR 1.5 to 3)) and POST (2 (IQR 2 to 3.5) groups (P = 0.07). Maternal health issues were discussed more frequently post-implementation. (Table) No other item was significantly more likely to be discussed following implementation.
Discussion: Checklist implementation did not result in an increased number of items being discussed; however, main maternal medical issues were discussed more frequently. Reluctance to change the traditionally-unstructured format of multidisciplinary rounds and the perception that the format would not improve communication may have contributed to these findings. Continued efforts to facilitate and encourage explicit discussion of patient information and intrapartum plans using standardized formats or other methods are warranted.
1) JCAHO. Sentinel event statistics. March 31,2006
2) Crit Care Med 2013;41:2015–2029
3) J Trauma Acute Care Surg 2012;73:S75–S82