Capstone Project: Patient Transfer from ER to Floor without SBAR
Introduction
The nursing practice has a goal of delivering quality health care and promoting health and wellness. The offered services ought to be safe, efficient, effective, timely, equitable and patient –centered. However, service delivery in hospital faces various challenges. The most important is maintaining the quality of care and continuity of care during patient handoff. A handoff occurs at the end of the shift or when a patient is transferred from one unit to another. It is important that the incoming care givers be fully briefed on the patient’s condition so as to continue offering quality services. Cohen & Hilligoss asserts that poor understanding of patient hand off and its effect on quality has led to poor handoff protocols (2010). It is especially important for proper handoff to be done when a patients is transferred from the ER to the floor. This is because the ER is not equipped to offer long term nursing care to patients. Therefore patients arriving in the ER are stabilized and then transferred to the hospital floor for proper nursing care. In this project, inefficiency in the transfer of patients from the Emergency Room (ER) to the floor is evaluated and possible interventions identified to improve care. Proper patient transfer protocols can act as a quality improving tool. This is when they are used to enhance patient care.
Current Situation Analysis
However the patient handoff is not done in person and usually ER nurses call the nurses on the hospital floor to inform them of the patient’s situation. Since the ER nurses are usually pressed of time due to the high rate of patient turnover, they do not offer comprehensive reports about the patients. In addition, the transporters who accompany the patient form the ER to the floor are not qualified to give a proper patient report. This lack of patient centric care has been affecting the quality of care on offer at the institution because most evaluations from the ER nurses is missed by the hospital floor nurses.
Team Building Skills
Effective communication is the binding factor in a team. All the team members need to feel appreciated and important and this can be best done through listening to their ideas. Effective communication also allows all team members to ask questions and to be answered. Communication is also important in conflict resolution (Leornard, Graham & Bonacum, 2004). In a team, conflict results from differences in personalities. Ideally, people with different personalities in a team should complement each other and balance the team. It is also possible for conflicts to result from similar personalities especially when people with similar skills can compete for the same role such as leadership positions.
Communication skills will be the driving factor behind the implementation of the new protocols to improve patients transfer from the ER the floor. This is because e the ER nurses will be required to conduct a bedside handover to ensure that the floor nurses understand the patient’s requirements. The floor nurses can then ask all the questions and information not captured in the hospital information and technology system.
Problem solving skills will be useful in solving problems that occur during a patient handover. This includes lack of bed space in the hospital floor requiring the patient to spend more days in the ER even after stabilization. Creative solutions such as providing nursing care to patients still in the ER to ensure that quality of the offered service is maintained will be implemented only when the team is performing optimally (Dixon, Larison & Zabari, 2006). Conflict resolution skills are by extension a part of problem solving skills. In a team setting, it is important for the members and especially the leaders to have conflict resolutions skills. In the transfers of patients from the ER to the floor, conflicts between the nursing team members can occur when there is a failure or an oversight from one party leading to blames. Ethical dilemmas are also common sources of conflict in a team. This is when personal choices and reasoning between the nurses in the ER and those on the Floor lead to a conflict in the type of care being offered to the patient. For instance, the floor nurses may disagree with the care recommended by the ER nurses. Conflict resolution skills enable the leaders to identify the cause of the conflict and to resolve it with a solution that is agreeable to all parties (Pascal & Greif, 2012).
Implementing the Changes in the Hospital setting
Patient transfer from the ER to the hospital floor has been identified as a major communication breakdown point at ABC hospital. The ER nurses do not give proper handover of patients to the hospital floor nurses and only rely on phone calls. Transporters who are not qualified to give medical reports accompany patients from the ER to the floor. Consequently the floor nurses do not get all the information that is required to continue offering care to the patient. The proposed changes in the patient handoff procedures are meant to be safe and easily to implement. This is based on the understanding that nursing systems need to accommodate human limits and capabilities and that often, nurses’ work under cognitive, perceptual and physical overloads (DeLucia, Ott & Palmieri, 2009). The proposed handoff system is based on SBAR, an acronym for Situation, Background, Assessment, and Recommendation.
SBAR is a communication protocol usually used to communicate between ambulance staff and ER workers when bringing a new patient. The SBAR standard protocols will be modified to reflect the communication needs of transferring patients form the ER to the hospital floor. These modifications on the standard SBAR protocols are in line with the recommendations of Pope, Rodzen & Spross who evaluated communication enhancement and patient outcomes resulting from SBAR (2008). The Situation report will focus on identifying the patient using name, age, sex and the reason for initial admission to the ER. The Background report will give the patients relevant medical history, the complaints the patient had on arrival to the ER and the procedures that have been conducted in the ER. The Assessment report will focus on the patient’s vital signs with special emphasis on the vital signs that are falling outside the normal range. The vital signs under consideration include temperature, heart rate, blood pressure, level of consciousness, pain scale and oxygen saturation. Under the Recommendations, the expectations of the ER nurse on the type of care that will be given to the patients. The recommendations part should be clear and concise but also allow for discussion between the ER nurses and the nurses on the hospital floor. Such discussions will foster teamwork and ensure that the patient gets the best care (Dixon, Larison& Zabari, 2006).
Under the new protocol, ER nurses will accompany the patient to the floor and give the SBAR verbally to ensure that the floor nurse understands that the needs of the patient. This will require the ER nurses to spend more time at the floor during patient transfers. To compensate for the reduced time efficiency, the number of ER nurses will be increased to ensure that the patient turnover in the ER unit is not affected. In addition, the floor nurses will be required to be more flexible and avail services to stabilized patients in the ER unit when there is no bed space to accommodate them in the hospital floor. There will be monthly meetings to evaluate the implementation of the new protocols.
The Impact of the proposed changes
The proposed changes will see better patient handoff from the ER to the hospital floor. The first impact of the proposed system will be on improved nursing care. When patients are transferred and handed over to the hospital floor nurses there will be enhanced quality of care. This is because of reduced errors as patient handoff has been identified as one of the most error prone hospital procedures (Sutcliffe, Lewton & Rosenthal, 2004). In addition, the patients will experience patient-centric care when they are handled by qualified staff in all stages of their hospital stay. Improved services will also be in terms of safety. For instance, when a personal handoff is made, the floor nurse can ask the ER nurse on all questions regarding the patients such as possible allergens to avoid exposing the patient to risks. This is in keeping with the nursing duty to provide safe services based on the doctrine of beneficence and non-maleficence (Butts & Rich, 2012).
The changes will also greatly enhance team work in the hospital. Modern day health care is based on the use of interdisciplinary teams offering holistic health care services. When nurses from different units learn to collaborate and perform in a team, their performance in interdisciplinary teams will be enhanced. This is because the skills such as leadership, communication, problem solving and conflict resolutions will be promoted among nurses. To the nursing practice, this is a positive impact which will allow nurses to take their rightful place in healthcare delivery. The major impact on the hospital management will be the requirement to add the number of nurses slightly to improve the nurses to patient ration and compensate for the additional time spent during patient handoff form the ER unit to the hospital floor.
Conclusions
The proposed changes will encompass the inclusion of a modified SBAR report when a patient is being transferred from the ER to the hospital floor. This is in contrast to the current system in which patients are transferred to the hospital floor by a transporter and the nursing floor nurse access the patient’s record from the hospital information system. The current system lacks a personal touch and when the ER nurses do not enter all information they gather into the computers, the system is prone to errors. At ABC hospital, patient transfer from the ER to the floor has been identified as a potential cause of breakdown in nursing care. To improve the situation, the proposed changes will be implemented using a team approach. This will first need the development of skills such as leadership, communications, problem solving, and conflict management among the nurses. The actual changes will be implemented using the standard SBAR communication protocol modified to suit the situation of transferring patient form the ER to the hospital floor within ABC hospital. The expected outcomes form the implementation will be improved health care quality due to high safety levels, and a better nurses-to-patient ratio within the hospital.
References
Butts, J. B., & Rich, K. (2012). Nursing ethics: Across the curriculum and into practice. New
York, NY: Jones & Bartlett Publishers.
Cohen, M. D., & Hilligoss, P. B. (2010). The published literature on handoffs in hospitals:
deficiencies identified in an extensive review. Quality and Safety in Health Care, 19(6), 493-497.
DeLucia, P. R., Ott, T. E., & Palmieri, P. A. (2009). Performance in nursing. Reviews of human
factors and ergonomics, 5(1), 1-40.
Dixon, J. F., Larison, K., & Zabari, M. (2006). Skilled communication: making it real. AACN
Advanced Critical Care, 17(4), 376-382.
Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: the critical importance of
effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(suppl 1), i85-i90.
Pascal, M. D., & Greif, W. (2012). Creating Effective Communication and
Teamwork for Patient Safety. In The SAGES Manual of Quality, Outcomes and Patient Safety (pp. 93-104). Springer US.
Pope, B. B., Rodzen, L., & Spross, G. (2008). Raising the SBAR: how better communication
improves patient outcomes. Nursing2012, 38(3), 41-43.
Runy, L. A. (2008). Patient handoffs. Hospital and Health Networks, 82(5), 7.
Sutcliffe, K. M., Lewton, E., & Rosenthal, M. M. (2004). Communication failures: an insidious
contributor to medical mishaps. Academic Medicine, 79(2), 186-194.
