Communication and teamwork skills are essential for providing quality health care, something we all strive for at UF Health. Providing the highest level of medical attention and the best possible patient experience begins and ends with effective collaboration among our health care teams. We all want to improve our patients’ quality of life, and they trust us to meet their needs to the best of our abilities.
How do we make sure that we are all on the same team with our patients, working together to achieve their goals? The answer is through communication with our patients and our colleagues throughout each patient’s experience at UF Health. We are always working to improve communication and adopt best practices. To this end, we must step back, pay attention and observe what’s being done and identify what we can do to make even more progress.
IN SITU SIMULATIONS | BUILD TEAM COMMUNICATIONS
At the UF College of Medicine Center for Experiential Learning and Simulation, or CELS, a critical objective is communication between interdisciplinary teams. Simulations once performed solely in the CELS are now mobile and more accessible for training health care providers, thanks to Mary Patterson, M.D., M.Ed., College of Medicine associate dean and the program’s director, and Tom LeMaster, M.S.N., M.Ed., R.N., the program’s director of operations. They joined UF Health last summer and now provide “in situs” — or mobile simulation education for different units throughout our UF Health hospitals in Gainesville.
The training involves lifesize and lifelike adult, pediatric and neonate mannequins that can be programmed to exhibit a host of physical functions, symptoms and reactions to mimic real-life scenarios in patient care. During a 30-minute simulation, a care team works together to respond to an unexpected patient emergency situation. Following the 10-minute scenario, the team spends 20 minutes conducting a debrief to assess the teamwork and communication that occurred. Debriefs focus on anything that came up or that could have occurred. Examples include discussion of closed-loop communications to how nurses prioritize the rapid-fire orders they were given.
Participants are expected to share “mental models”. Mental models — defined as psychological representations of real, hypothetical or imaginary situations — are a major component of a simulation. All participants are encouraged to share, identify challenges and learn together. They require the team leader to recap what happened and ensure that people speak up and questions are answered.
Another component of a simulation is to identify latent safety threats. These could include noting missing equipment or recognizing technology with which a provider or team may be unfamiliar. This provides the team an opportunity to prepare for the unknowns they may face in a critical response situation.
The final step in a simulation is determining if a process works. The team walks through each instruction and step in the care protocol to determine its efficacy. For example, if a team member has to call a phone number for support, does that number actually reach the right person who can provide assistance? All these checks contribute to quality clinical care and a safe patient outcome.
“When we do a simulation, we are really looking for it to be with an interdisciplinary team,” LeMaster said. “If a team requests a simulation, we always ask that everyone on the unit be involved. That way, they can work together and feel empowered to speak up within the group when a real emergency situation happens.”
The CELS program simulation team looks at very specific objectives, including clear and specific communications among the team.
“There’s always a strategic purpose for what we’re doing. If we offer simulation, we can focus on the technical aspects of the case and the team developing a shared mental model, working together and communicating effectively.”
BEST PRACTICES FOR PATIENT BEDSIDE HANDOFFS
The UF Health Shands Cancer Hospital Orthopaedic Surgical Unit 6 West team has been recognized for best practices in patient bedside handoff communications. These occur when nurses switch shifts and the outgoing team provides a report to the next team about each patient’s care and needs.
With the help of the UF Health Shands Nursing and Patient Services Unit Practice Council, staff on this unit advanced bedside handoffs from their previous version and adopted research-backed best practices. Before a handoff occurs, the nursing team now completes tasks such as helping a patient to the bathroom and assessing his/her medication needs. They found that this practice allows reports to go more smoothly with fewer interruptions.
The Unit Practice Council also developed a brochure to inform patients about what happens during shift change so they can anticipate and be more comfortable during the report process. The team created laminated cards to guide nurses through the handoff protocols and ensure consistency. The unit also developed a MyTraining online module to educate staff on the new and improved processes.
Following these changes, the staff conducted one-on-one observations and confidence check–offs, so everyone involved is fully informed and empowered.
“It reflects very highly on our hospital,” said Elizabeth Hicks, M.S.N., RN-BC, the nurse manager for Orthopaedic Surgical Unit 6 West. “I’ve heard patients say they really like the communication and being able to add to the reports, and they haven’t seen this in any other hospitals. It shows patients that we really care.”
BEDSIDE INTERPRETATION SERVICES
Our hospitalized patients and families with limited English proficiency, or LEP, can now more easily access language services with Stratus bedside interpreter technology. At our cancer hospital and heart and vascular and neuro hospitals, we now offer 415 iPads as part of the Sonifi patient infotainment system with the Stratus software. The plan is to extend this technology to all our hospitals.
Stratus provides video and audio interpretation services for LEP patients who do not speak English. Stratus provides 26 languages available for video chat interpretation and over 200 languages available for audio interpretation. The service is offered 24/7 and also provides American Sign Language video interpretation to patients who need it. Patients feel relief and comfort knowing they can be supported almost immediately at the bedside.
“For patients and providers, Stratus’ video remote interpreting capabilities allow for a more personal experience than over-the-phone interpreting because VRI combines the benefits of face-to-face interpretation with the on-demand nature of OPI,” said Ronald “Bo” Ginn, the Patient Experience department director in the UF Health Sebastian Ferrero Office of Clinical Quality and Patient Safety.
The six-month pilot program rolled out in January and has earned positive feedback from patients, physicians and nurses, said Anne Meiring, LCSW, CPXP, manager for Patient Experience and Language Access.
Before Stratus, Meiring said it was a challenge for LEP patients to be connected to an interpreter. While the CyraCom Blue phones are still a great resource for interpretation, she said patients love how Stratus can connect them with an interpreter in an instant. Many of these patients feel lost and scared of entering a health care environment where no one may understand their needs.
“Stratus is the technology that will provide the respect and empathy these patients deserve,” Meiring said. “It is my hope that Stratus is the future for interpreting services at UF Health Shands. Language access is so important and communication is the heart of health care. More effective interactions with patients ensures patients with LEP and hearing impairment will receive the best treatment possible.”
She added, “This service not only improves patient safety but it also improves patient satisfaction. Providing appropriate language access for LEP patients and families is not just about safety. Effective communication is critical to the patient experience.”