Improving transparent team communication with the ‘Glass Door’ decal communication tool: a mixed methods analysis of family and staff perspectives

BMJ Open Quality

article

Gabrielle Cunnigham¹  Matthew Park¹  Ronald Gottesman²  Samara Zavalkoff²  Maud Mazaniello-Chezol⁴  Shauna O'Donnell³  Kadine Cunningham¹  Mohammed Almazyad⁵  Ashley O'Reilly¹  Kimberley Macedo⁶  Kimberly Lammeree⁶  Ellen Mitchell¹  Chrysanthi Roussianos¹  Marie Antonacci¹ 

[1] Montreal Children's Hospital;Pediatric Critical Care , McGill University;Research Institute of the McGill University Health Centre;Family Medicine , McGill University;Pediatrics , King Saud University College of Medicine;Family Partner , Montreal Children's Hospital

关键词: critical care;    quality improvement;    patient safety;    communication;    patient-centred care;   

DOI  :  10.1136/bmjoq-2021-001507

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

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.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND