Table 1

Interventions tested

InterventionReason chosenInterventions trialledActionAction reasoning
Track board Comments Column useNursing survey showed nurses often do not understand reasoning for testing or physician thought process.Added differential diagnosis and planned test to comments column on patient track board.AbandonedConsistently used, but no improvement in patient rating of communication consistency noted after implementation.
Team structureInability to predict who a patient's provider or nurse is.Divided nursing and providers into three teams based on geographical location.AbandonedNursing shift changes and staffing differed from provider shifts making team alignment operationally challenging. Realignment felt not feasible at current time.
Nursing triage communicationVariable information shared.Standardise language included in nursing chief complaint.AdoptedNon-verbal process allowing providers to script their introduction based off nursing notation gives perception of shared communication. As an example, prior to standardisation a chief complaint may be listed as ‘abdominal pain’ whereas after standardisation, chief complaint would include a comment such as ‘right lower quadrant abdominal pain x2 days, parental concern for appendicitis.’
Consultant communicationVariable process of how and when consultant evaluated patient and communicated with team.Used scripting during consultation to speak with ED team in person prior to patient evaluation and signs posted on doors to remind.AbandonedOn shifts tested did not lead to consultant behavioural change. Investigated EMR process change to notify ED team when consultant has seen patient, but much variability noted in consultant notation and order usage with regard to timing of evaluation.
Whiteboard useAdditional mode to communicate with family and ED team.Whiteboards hung on wall in room. Tested consistent use of team member names and medical plan written on the whiteboards. PDSA's focused around process to assure markers always present at board, location of whiteboard relative to patient location in room, and content included on boards.AdoptedImprovement noted in communication consistency scores after usage improved and nurses and providers felt it helped additionally communicate plan between ED team as well.
Personalised communication device assignmentNo standard way to find or contact provider as previously did not regularly carry a phone or communicate phone number in EMR.Standardised assignment of personalised communication devices to providers and nurses at start of shift along with numbers updated within EMR.AdoptedNursing and physicians noted improved ease of contact after implementation.
Entire ED shift sign-outNoted variable situational awareness of department between nurses and providers.Charge nurse and all ED providers huddled at shift change.AbandonedCharge nurse too busy to consistently join and overlapping provider team times made coordination very challenging. Operational changes needed felt not feasible.
Stepping stonesLack of family knowledge of ED processes and variable expectations.Developed pictorial describing all team members, typical process and typical times for visit, labs or imaging. PDSAs focused on how to give information—handing in person on arrival, handing in person once in room and hanging in rooms.AdoptedImproved satisfaction noted after use and operationally, hanging in room with scripting to families to identify pictorial led to most effective process.
  • ED, emergency department; EMR, electronic medical record; PDSA, Plan-Do-Study-Act.