Improving Communication and Workflow Among Advanced Practice Providers and Nurses on Night Shift in an Intensive Care Unit.

Abstract

Background: In critical care settings during night shift, the number of staff members is reduced and a designated time for structured patient care discussions is often absent. The absence of organized collaboration and shared decision-making strains professional relationships.

Local problem: In a 21-bed cardiovascular intensive care unit, advanced practice providers were frequently interrupted by night shift nurses to discuss nonurgent clinical matters while engaged in patient care activities.

Methods: This quality improvement project used a preintervention-postintervention design. Surveys were distributed to advanced practice providers and nurses to determine perceptions of communication. All advanced practice providers and nurses working night shift in the cardiovascular intensive care unit were included. Nightly bedside rounds for advanced practice providers and nurses using a goal sheet to improve communication were implemented in the cardiovascular intensive care unit. Preintervention and postintervention scores on survey subscales (perceptions of collaboration, workflow, and communication) were examined with analysis of variance for both groups.

Results: Mean scores increased after the intervention for both advanced practice providers and nurses. Scores for perception of collaboration significantly increased for both advanced practice providers and nurses (both P = .01). The score for perception of workflow significantly increased for nurses (P < .001) but not for advanced practice providers. Scores for perception of communication did not significantly change for either group.

Conclusion: Implementation of bedside rounds using a goal sheet for advanced practice providers and nurses working night shift in the cardiovascular intensive care unit improved perceptions of collaboration and workflow.