vishal vyas foundation year 1 doctor barnet and chase farm hospitals nhs trust academic foundation...
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Vishal VyasFoundation Year 1 DoctorBarnet and Chase Farm Hospitals NHS TrustAcademic Foundation Year 1 Representative for London Deanery
Background
Methods
Results
Conclusions
Limitations
Literature
Acknowledgements
Inter-professional telephone communication during on-call shifts felt to be of a highly variable quality.
For a significant proportion of received telephone calls, FY1 doctors felt they had an inadequate handover.
Poor written/verbal communication – one of the most common sources of serious error.
No data available to quantify/validate the quality of communication at Barnet and Chase Farm Hospitals NHS Trust. SBAR is the ‘official’ handover tool used by the Trust.
Structured method of communication between health professionals.
Simple and effective; well-established in military, aviation and acute medical settings.
Ensures critical information that required urgent attention/action communicated.
Effective escalation and improved safety.
4 steps: Situation, Background, Assessment, Recommendation.
Reduces barriers to communication between different health care professionals/ levels of staff.
Takes the uncertainty out of communication through a ‘shared mental model’.
Easy to remember
Nurse-doctor, doctor-doctor, between other allied health professionals etc.
Change of shift e.g. handover meeting
Escalating a concern
Telephone handover/referral
Urgent or non-urgent
Inpatient or outpatient
Prospectively designed data collection sheet, trained FY1 doctors asked to rate calls received by healthcare professionals.
Communication across Trust and across medical/ surgical wards.
Data collected on the caller e.g. doctor/nurse, grade, location of caller.
FY1 doctors rated the quality of calls: Likert scale of 1-10 how useful were the calls in
helping them to prioritize tasks
Health Professional
Number of calls
Doctor 34
Nurse 31
Total 65
Doctor Grade
Number of calls
FY1 12
SHO 13
SpR 8
Consultant
1
Total 34
Nurse Grade
Number of calls
Staff Nurse
25
Sister/Charge Nurse
5
Senior Sister/Senior Charge Nurse
1
Total 31
p=-0.0004
*
* = p=<0.0001
*
* = p=<0.0001
*
* = p=<0.0001
Majority of calls used SBAR (72%) with the overall communication being rated at 8/10.
Overall, calls using SBAR were rated as significantly better than those did not use SBAR (median 9 vs. 4, p=<0.0001)
Calls using SBAR consistently significantly better across doctors and nurses and throughout the various grades.
A sizeable proportion of staff nurses did not use SBAR (44%) with the median rating of communication significantly lower (4) compared to when SBAR (7) was used (p=<0.0001).
Small sample size (n=65 telephone calls)
Only FY1 on-call observers to receive calls
Single Trust sample – difficult to extrapolate data to other trusts
Lack of data on quality of care/patient outcomes
Need for formal education programme
SBAR improved nurse-doctor communication leading to better documentation and fewer unexpected deaths1
SBAR improved ‘call impact’ in telephone from junior doctors and reduced the time taken to present the referral21De Meester K, Verspuy M, Monsieurs KG, Van Bogaert P. “ SBAR improves nurse-physician communication and reduces
unexpected death: A pre and post intervention study”. Resuscitation 2013 March 26 . http://dx.doi.org/10.1016/j.resuscitation.2013.03.016
2Cunningham NJ, Weiland TJ, van Dijk L, Paddle P, Shilkofski N, Cunningham NY. “Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting.” Postgrad Med J Nov;88!0145):619-26
All staff at Barnet and Chase Farm Hospitals NHS Trust particularly FY1 colleagues for their assistance in kindly rating calls and collecting data
Dr James Dooley