Improving Communication

Improving Communication Between PICU
Staff and Our Patients and Families
Improving Communication
Between PICU Staff and Our
Patients and Families
Terri Hedlund, RN, BSN, CPN
Quality Outcomes Coordinator
Connie Neuzerling, RN, BSN
Senior Partner, CVS Clinical Program
Specialty Coordinator
Susan Willock, RN, BS, BSN, MEd, CCRN
Senior Partner,
Clinical Specialty Coordinator
Special Thanks
Special thanks to our coach, Terry Stanley; our CNO, Marilyn
Cox; our CEO, Jeff Sperring; our Clinical Director, Maureen
Hancock; our Clinical Managers, Louann Corley-Perdue, Laura
Alter, and Jamie Sowers; but most importantly we want to
thank the staff on the PICU without whose fantastic
dedication to our patients and their families this project
would not have been possible.
Overall Purpose of Our Project
Improving Communication Between PICU Staff and
Our Patients and Families:
 Improves trust and confidence in the bedside nurses
 Improves patient/family satisfaction
 Increases family participation in, and understanding of, the
plan of care
 Promotes goal-directed care for patients
Additional Benefit Includes:
 Decreases length of stay
Action Plan
 June – Placed announcement in Weekly Huddle
 July – Group met with clinical director and clinical
managers
 August – Created poster about
project for staff
Action Plan
 September – Conducted Appreciate Inquiry
 Met with nurses on a unit that had consistently improved their
patient satisfaction scores
 September – Met with family as faculty group
 November – Presented to IU Health Leadership Group
 November and December – Created and revised staff
education
 Finalized rollout plans
 Created logo
Action Plan
 January – Educated 180 RNs over a 2-week period
 Ancillary staff also given education on initiative
 RTs, PSAs, PCAs, PT/OT, Child Life, Music Therapy
 February 1 & 2 – Rollout pizza party, presented staff with
gifts
 All staff who work on or with the PICU
 February – Staff physician photos
posted in all patient rooms
Action Plan
 Ongoing – Collecting data
 Responses on parent questionnaire
 Performing white board and rounding sheet audits
 Presenting information to multiple
leadership teams, multidisciplinary
councils, etc.
Rollout Party
Project Goals
Short-Term Goals:
 To improve staff communication with patients/families, as
evidenced by responses on parent questionnaire and by
NRC Picker question, “How often did the ICU nurses
explain things in a way you could understand?”
 Immediate data would be available from questionnaire,
and Picker data would be available after first quarter.
Project Goals
Medium-Term Goals:
 Improve family/staff communication and increase family
participation in plan of care.
 Immediate data from parent questionnaire, second
quarter NRC Picker scores for the questions, “How often
did you have enough input or say in your child's care in the
ICU?” and “How often did the ICU nurses explain things in
a way you could understand?” Also immediate data from
audits of white board.
Project Goals
Long-Term Goals:
 Improved family/staff communication
 Increased family participation in plan of care
 Family voices understanding of plan of care
 Increased patient satisfaction scores
 Decreased LOS
Project Goals
Long-Term Goals:
 Immediate data available from parent questionnaire and
quarterly NCR Picker scores for the questions, “How often
did you have enough input or say in your child's care in the
ICU?”, “How often did the ICU nurses explain things in a
way you could understand?” and “How often did you have
confidence and trust in the ICU nurses treating your
child?” Also immediate data from audits of white board.
Key Challenge
Time!
 Educating 180 nurses
 Unit very busy with high patient acuity
 Difficult to get out of staffing or leave bedside
 Difficult to find time to work on project or for team to
meet
 Phone conferences when face-to-face meetings not possible
 Lots of e-mails
Financial Implications
 In the pediatric world, it is difficult to assign a dollar
amount to patient satisfaction and families’ involvement
in the care of their child. This will become increasingly
important with the implementation of pediatric HCAHPS.
 This will translate into improved patient satisfaction scores.
 Reduced readmission rates will be achieved as families are better
prepared to care for their child.
 At Riley Hospital for Children, it is estimated that the
impact of patient satisfaction on reimbursement will be
approximately $1,358/Medicare patient.
Supporting Evidence
 Length of stay for ICU patients can depend on a range of
non-medical factors, including effectiveness of
communication and presence of conflicts between and
among members of the patient’s family and staff. 1
 Parents of children in a PICU view information and
communication with the healthcare team as key
components of quality care. 2
Impact of Goal-Directed Care
 Evidence demonstrates goal-directed care decreases the
length of stay, which will have significant financial impact.
 Cost of an “average” PICU stay (room/board) is
$1,542/day.
 Annual number of patients in the PICU is 2,374.
 Average length of stay in the PICU is 3.8 days.
Hospital’s Financial Impact
 If this project decreases the average length of stay in the
PICU by ½ day, the cost savings for ONE YEAR could be up
to:
$1,830,354
 This does not include the effects of patient satisfaction &
reduced readmission rates.
National Average Cost Savings
 Average cost of an ICU stay is $3,500/day. 3
 Decreasing the LOS by 0.5 day saves $1,750 per patient
 With projected cases of 2,374 patients for 2013, the
projected annual savings using the national average would
be $4,154,500.
Thank You!
We want to thank AACN & IU Health for the opportunity to
participate in the CSI Academy. We will use what we have
learned to continue to bring about positive change &
improved outcomes for our patients in the PICU.
References
1. Shelton W, Moore CD, Socaris S, Gao J, Dowling J. The effect of a
family support intervention on family satisfaction, length of stay, and
cost of care in the intensive care unit. Crit Care Med. 2010;38(5):13151320.
2. Kleiber C, Davenport T, Freyenberger B. Open bedside rounds for
families with children in pediatric intensive care units. Am J Crit Care.
15(5):492-496.
3. Dasta J, Mclaughlin T, Moody S, Piech C. Daily cost of an intensive care
unit day: the contribution of mechanical ventilation. Crit Care Med.
2005;33(6):1266-1271.