Communication Boards: Design and Implementation to Improve Patient Experience
BACKGROUND
In a high-risk inpatient birth center, a patient’s trajectory of care will move her through 4 possible phases: Triage, Antepartum, Labor & Delivery, and Postpartum. As patients progress through these areas, their plan of care and care teams change. In 2007, the Joint Commission’s (TJC) landmark study recognized communication failures were at the root of most sentinel events. In 2010, the TJC published the “Roadmap for Hospitals” to advance effective communication and safety by encouraging patient and family engagement in care.
PICO QUESTION
Does the use of a comprehensive white board in an inpatient birth center affect communication among nurses, physicians, and patients?
METHODS
Over a three-month period, nurses, unit directors, providers and educators collaborated to design new communication boards for patient rooms. This collaboration created staff engagement for implementing the new tool. Education was provided on how to effectively use the new boards in staff meetings and emails. Unit champions served as role models by filling out new boards correctly and updating boards consistently each shift. Feedback and compliance data were collected pre- and post-installation of whiteboards via surveys and audits.
RESULTS
Compliance audits revealed pre-intervention communication boards were completed on average 45% compared to post-intervention boards completed 78%. Therefore, on average, with this intervention patients are receiving 33% more information about their care. In anonymous staff surveys we asked, “How useful are the communication boards?” Pre-intervention, staff rated usefulness to be 32%; post- intervention staff rated usefulness to be 78%, an increase of 46%.
Furthermore, we asked a version of our PICO question, “Do boards facilitate communication between care team and patients?” Pre- intervention 25% of staff responded “usually” or “always”. Post- intervention 70% of staff responded “usually” or “always”, an increase of 45%.
We asked for comments and feedback from staff and patients in staff surveys and during random bedside audits. Feedback from patients and staff on communication boards was resoundingly positive: patients appreciated the information shared on the boards and staff felt the revised boards prompted collaboration and patient-centered care.
DISCUSSION
Audit results showed new communication boards are utilized 33% more and staff surveys confirmed new boards are significantly more useful and facilitate communication between patients and staff. Next steps will compare Press Ganey and HCAHPS data pre- and post-intervention to see if boards make a positive difference in our communication scores.
Nurses identified two barriers to compliance: dry erase pens were stored inside cabinets out of sight and historical habits were acknowledged. In the past some staff did not utilize boards and found it difficult to develop new habits.
To address these barriers dry erase pen caddies were mounted next to communication boards in clear line of sight for staff and patients and educational presentations were created for provider teams to encourage a habit of writing names on the boards when entering patient’s rooms.
IMPLICATIONS
A well-designed communication board is an inexpensive, effective tool to promote communication and safe, patient-centered care. Communication Boards can reinforce safe practice, facilitate provider communication and improve patient experience.