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Clinician Communication is Key to Patient Safety

Guest blog
04/25/18

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Kristine A. Edson, MS, BSN, RN, CMSRN, CNE, Clinical Educator and Nurse Residency Program Coordinator, Medstar Georgetown University Hospital

It's 6:45 p.m., near the end of your third 12-hour shift in a row. The night shift will be arriving any second, and then you are off for four days. You decide to round on your patients one final time before report. 

Ms. Edmund in Room 3 said she didn’t feel well earlier and appeared a little tired, but it was probably due to pain from her recent back surgery. You peek in to find her sitting in the chair where you left her an hour ago. You call out to let her know you are about to change shift and ask if she wants to go back to the bed to rest. There is no response. You move closer and touch her arm but she doesn’t respond.  

You quickly realize she is not breathing and scream, "Code blue!" into the hall. You begin CPR, the code team arrives almost immediately and tasks are quickly delegated. Individual physicians and nurses aren’t providing the care; it’s being delivered by a team, united to achieve a common goal: get the patient breathing again.  

In health care, there is a common misconception that nurses and physicians operate in separate worlds. In reality, neither group could do its job without the other. Studies repeatedly show that hospitals with high levels of collaboration between physicians and nurses experience better patient outcomes. Yet no programs exist to help train new-to-practice clinicians (nurses and physicians) how to effectively communicate with one another or give them a foundation on patient safety. In fact, despite the importance of this teamwork in the acute-care setting, many nurses and physicians work together for the first time only after they have begun practicing.

Health care providers already face the challenge of treating patients to prevent all safety events. New-to-practice clinicians face the additional challenge of learning to advocate and communicate effectively in real-life situations. Without adequate exposure to and practice with interdisciplinary teamwork, these clinicians are placed at further disadvantage.

With this in mind, an interdisciplinary safety immersion day was established at Medstar Georgetown University Hospital and the Georgetown University School of Medicine. Approximately 100 new-to-practice nurses and 200 third-year medical students (right before they begin their clinical experience) take part in a day committed to patient safety and communication. The participants are divided into groups led by a facilitator to help guide conversation. Half of the day consists of team-building activities while the other half is spent listening to personal stories, engaging in discussion and participating in interactive skits. 

One team-building activity begins with a 10-foot board balanced on a cinder block. Placed under each end is an egg, representing a patient. Each team works together to balance all members on the board simultaneously without "killing" their patient. Although it may sound ridiculous (and certainly makes for a funny photo op), this activity requires the same teamwork as the code scenario described above. The team has a common goal: don’t crush the egg, i.e., keep the patient alive. In teams with multiple members arguing different opinions, the result is a runny yolk on the hospital floor and a request for a new “patient.” Teams that are able to communicate clearly, on the other hand, are able to complete their mission.

Participants over the past two years have reported that the interdisciplinary day improves relationships, interactions, and collaboration between medical students and new-to-practice nurses. One medical student shared, "Interactive exercises with the nurses were good for understanding the importance of communication among the team." The participants also reported a greater understanding of patient safety and the impact of safety issues on patients, families and the care they provide.

By training new-to-practice clinicians to work as interdisciplinary teams, patients like the fictional yet familiar Ms. Edmund are provided with the best possible care.

About the author. In her current role, Kristine Edson serves as an educational and professional development expert for both new-to-practice and established nurses. She is responsible for the overall coordination and management of the new-to-practice nurse residency program, including collaboration with nursing leadership, curriculum development and implementation, and evaluation of resident progression. She also functions as adjunct faculty for the Georgetown University School of Nursing. Edson joined Medstar Georgetown University Hospital in 2009 as a new-to-practice nurse, having just graduated with her bachelor’s degree in nursing from the University of Virginia. She worked as a neuroscience and medical-surgical nurse, and received her master’s degree in nursing education from Georgetown University in 2014. She is certified in her specialties as a medical-surgical nurse and nurse educator.

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