HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Narasimhan, M. Articles by Rosen, M. J. Search for Related Content PubMed Articles by Narasimhan, M. Articles by Rosen, M. J.

Improving Nurse-Physician Communication and Satisfaction in the Intensive Care Unit with a Daily Goals Worksheet

Beth Israel Medical Center, New York, NY

PURPOSE: This study evaluates the impact of using a standardized worksheet on physican and nurse perceptions of understanding of the goals of care. The effect of this intervention on intensive care unit (ICU) length of stay (LOS) was also assessed.

METHODS: This study was conducted in a 16-bed Medical ICU at Beth Israel Medical Center, a large urban teaching hospital. The worksheet lists daily goals, is completed on morning rounds, and is posted at the bedside. The worksheet is comprised of sections to record information regarding tests/procedures, medications, sedation, analgesia, lines and catheters, consultations, nutrition, mobilization, family discussion and consents, and disposition. Attendings, residents and nurses were given a questionnaire before and six weeks after implementation of the worksheet. Responses to evaluate understanding were scored on a 5-point scale (1=understand nothing, 5=understand completely). Quantitative variables were analyzed using a t-test and qualitative variables using chi-square.

RESULTS: For the three months since this worksheet was used, ICU LOS averaged 4.44 days, compared with an average LOS of 6.26 days over the same three months one year earlier.

CONCLUSION: Use of a daily worksheet during daily multidisciplinary ICU rounds led to improved perception of nurses’ understanding of the goals of care and communication with physicians. For physicians, the only significant changes were improved understanding of daily tasks and improved communication with nurses. Physicians and nurses expressed a desire to continue using these worksheets. Use of the worksheet was associated with a 29% reduction in ICU LOS.

CLINICAL IMPLICATIONS: Use of a simple communication tool on daily Medical ICU rounds can lead to improved nurse-physician communication and satisfaction and may be associated with reduced LOS.

Before Worksheet 6 Weeks after Worksheet P value Nurses Understand goals of care (mean score) 3.95 4.83 0.001 Understand tasks (mean score) 4.43 4.67 0.28 Understand plans for transfer (mean score) 4.09 4.33 0.35 Nurse-physician communication (mean score) 3.57 4.25 0.03 Would you like to use a daily worksheet? 15/21 (71%) 13/14 (93%) 0.02 Physicians Understand goals of care (mean score) 4.58 4.90 0.03 Understand tasks (mean score) 4.75 5.00 0.08 Understand plans for transfer (mean score) 4.42 4.47 0.08 Nurse-physician communication (mean score) 3.42 4.70 0.01 Would you like to use a daily worksheet? 12/12 (100%) 9/14 (64%) 0.07

DISCLOSURE: M. Narasimhan, None.