A significant number of patients die every year in United States hospitals due to medical error or delay in emergent patient care. One important source of medical errors or delay in care is lack of effective communication between nurses and physicians. A common aspect of inpatient care that involves communication between physician, nurse and patient is emergent blood tests. Stat labs are frequently ordered for patients on the medical floor, however the average time for order to collection is 1 hour 46 minutes in our hospital setting.
The goal of this study was to decrease the delay in stat lab collection through implementation of a standardized communication model between nurses and residents whenever a stat lab was ordered. The model used was “Closed Loop Communication”, which is also utilized in the military and aviation setting.
First, a resident Visual Checklist (in the form of a poster) and standardized nurse education emails were disseminated to train nurses and residents in “Closed Loop Communication”. The loop was twofold: The resident would notify the nurse directly at the time of ordering a stat lab, then the nurse would directly notify the resident within half hour if unable to obtain the specimen. A pre and post survey was administered to 30 nurses and 30 residents on the general medicine floors to assess for compliance with the intervention. Unpaired two tailed t test was done to evaluate for statistical significance. The second step of this study was to compare the time lapse between “Order to Specimen Received in Lab” Pre and Post Intervention with two tailed t test.
The resident survey showed that pre‐intervention nurses were notifying residents 33% of the time, which increased to 63% after intervention (T=3.94, DF=57, P < 0.05). The nursing survey showed that residents were notifying nurses 62% of the time, which increased to 82% after intervention (T=3.33, DF=57, P < 0.05). Pre‐intervention, from 11/2012 to 5/2013, the mean time between stat lab ordered and specimen received was 1 hour 45 minutes (2317 specimens). After the intervention, from 9/2013 to 11/2013, the mean time between stat lab ordered and specimen received was 1 hour 36 min (355 specimens; unpaired two‐tailed t‐test, T=15, DF= 2670, P < 0.01).
The first arm of the loop, residents notifying nurses when ordering a stat lab, improved after utilization of the visual checklist. The second arm of the loop, nurses notifying residents within half hour if unable to obtain labs, also improved significantly with the use of Nursing Education Emails. Moreover, the time between ordering of an emergent lab and specimen reception decreased significantly. This closed‐loop communication system will hopefully decrease delays in emergent medical care.
To cite this abstract:Sharma A, Offurum A, Gulati M. Z136 — Closed Loop Communication Between Nurses and Physicians. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 136. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/z136-closed-loop-communication-between-nurses-and-physicians/. Accessed April 21, 2019.