Team Communication & ACE

The Joint Commission identified communication as one of the root causes in over 60% of reported sentinel events in 2013 (2004-2013) and another study found communication to be one of the top two contributing factors in analysis of over 70 medical mishaps. Clearly even without considering healthcare we often misunderstand one another, and when someone’s care is on the line its not something we can leave to chance. I spent my summer working on a Acute Care for the Elderly (ACE) unit looking specifically at various measures of safety and quality. Besides significantly lowering readmission, reducing average length of stay, and allowing the unit to go over 150 days before their first fall (and they have only had 3 in 10 months), the unit also showed increased satisfaction among all staff compared to the rest of the hospital, and a perception of better communication between physicians and nurses. Most of all patients and families reported strong positive feedback after spending time on this unit.

Logically a very complex set of procedures and protocols must’ve been responsible for these changes. Actually quite the opposite. The changes made to this unit were something even I – as a starting second year medical student – could have come up with. The ACE unit practices Structured Interdisciplinary Bedside Rounds (SIBR) – originally developed by Dr. Jason Stein at Emory. Each morning at 10am – not 7am – when families can be present, the geriatrician, NP, social worker, RN, PCA, OT, PT, and dietician round together on all 10 patients on the unit (the structure allows it to take under an hour). I can truly say amongst this 4-south unit there is a flat hierarchy where the PCA feels as comfortable to bring up a concern as does the MD to admit he or she hadn’t considered something. Its such a simple and almost obvious way to deliver care but it’s occurring on only 10 beds in this hospital and likely on none in many institutions.

If you’re trying to describe the placement of a domino to someone who cannot speak back and cannot see the picture of the end goal the results are some poorly placed game pieces. If care plans are being communicated via electronic notes with little opportunity for clarification the result could be much worse. A little logistics and coming together to change the culture can flatten the hierarchy to allow this seamless team communication elsewhere. I am inspired that what I watched all summer fits so well with the ideas we are learning here at Telluride East, and I cannot see myself being content with anything less than this type of teamwork.