RT Journal Article
SR Electronic
T1 Improving transparent team communication with the ‘Glass Door’ decal communication tool: a mixed methods analysis of family and staff perspectives
JF BMJ Open Quality
JO BMJ Open Qual
FD British Medical Journal Publishing Group
SP e001507
DO 10.1136/bmjoq-2021-001507
VO 10
IS 3
A1 Samara Zavalkoff
A1 Maud Mazaniello-Chezol
A1 Shauna O'Donnell
A1 Kadine Cunningham
A1 Mohammed Almazyad
A1 Ashley O'Reilly
A1 Kimberley Macedo
A1 Kimberly Lammeree
A1 Ellen Mitchell
A1 Chrysanthi Roussianos
A1 Marie Antonacci
A1 Gabrielle Cunnigham
A1 Matthew Park
A1 Ronald Gottesman
YR 2021
UL http://bmjopenquality.bmj.com/content/10/3/e001507.abstract
AB Objective To determine the value and perspectives of intensive care unit (ICU) healthcare professionals (HCPs) and families about the Glass Door (GD) decal team communication tool.Design Quality improvement methodology was used to design, test and implement the GD. Uptake was measured through audit. Impact was assessed through mixed methodology (survey of ICU HCPs (n=96) and semi-structured interviews of HCPs (n=10) and families (n=7)).Setting Eighteen bed, closed, mixed medical–surgical–cardiac ICU in a tertiary care, university-affiliated, paediatric hospital.Population Interdisciplinary ICU HCPs and families of children admitted to the ICU.Intervention A transparent template (the GD) applied to the outside of ICU patients’ doors with sections for HCPs names, physiological goals and planned tests and treatments for the day. Medical staff completed the GD in rounds (AM and PM) and any HCP caring for the patient updated it throughout the day.Measurements and main results After 3 months, 96% of 613 doors were employed of which 99% respected confidentiality. ICU HCPs reported improved understanding of the patient’s plan (84% today vs 59% pre-GD, p<0.001) and sense that families were up-to-date (79% today vs 46% pre-GD, p<0.001). Based on semi-structured interviews, the GD promoted a shared understanding of the plan contributing to care continuity. The GD reassured families the team is working together and fostered family engagement in the care. Routine family experience surveys showed no change in families’ sense of privacy during admission; families denied the GD’s anticipated compromise of confidentiality.Conclusions The GD decal communication tool, visible on the patient’s door, improved ICU HCPs’ perceived knowledge of their patient’s plan. The GD improved the shared mental model, facilitated teaching and information transfer and fostered family engagement. Challenges included knowing the rules for use and consistent application. Concerns initially raised by HCPs about confidentiality were denied by families.Data are available upon reasonable request. De-identified survey data and de-identified qualitative semi structured interview transcripts are available upon request from the lead author by emailing samara.zavalkoff@mcgill.ca.