Vishal VyasFoundation Year 1 DoctorBarnet and Chase Farm Hospitals NHS TrustAcademic Foundation Year 1 Representative for London Deanery

Background

Methods

Results

Conclusions

Limitations

Literature

Acknowledgements

Inter-professional telephone communication during on-call shifts felt to be of a highly variable quality.

For a significant proportion of received telephone calls, FY1 doctors felt they had an inadequate handover.

Poor written/verbal communication – one of the most common sources of serious error.

No data available to quantify/validate the quality of communication at Barnet and Chase Farm Hospitals NHS Trust. SBAR is the ‘official’ handover tool used by the Trust.

Structured method of communication between health professionals.

Simple and effective; well-established in military, aviation and acute medical settings.

Ensures critical information that required urgent attention/action communicated.

Effective escalation and improved safety.

4 steps: Situation, Background, Assessment, Recommendation.

Reduces barriers to communication between different health care professionals/ levels of staff.

Takes the uncertainty out of communication through a ‘shared mental model’.

Easy to remember

Nurse-doctor, doctor-doctor, between other allied health professionals etc.

Change of shift e.g. handover meeting

Escalating a concern

Telephone handover/referral

Urgent or non-urgent

Inpatient or outpatient

Prospectively designed data collection sheet, trained FY1 doctors asked to rate calls received by healthcare professionals.

Communication across Trust and across medical/ surgical wards.

Data collected on the caller e.g. doctor/nurse, grade, location of caller.

FY1 doctors rated the quality of calls: Likert scale of 1-10 how useful were the calls in

helping them to prioritize tasks

Health Professional

Number of calls

Doctor 34

Nurse 31

Total 65

Doctor Grade

Number of calls

FY1 12

SHO 13

SpR 8

Consultant

1

Total 34

Nurse Grade

Number of calls

Staff Nurse

25

Sister/Charge Nurse

5

Senior Sister/Senior Charge Nurse

1

Total 31

p=-0.0004

*

* = p=<0.0001

*

* = p=<0.0001

*

* = p=<0.0001

Majority of calls used SBAR (72%) with the overall communication being rated at 8/10.

Overall, calls using SBAR were rated as significantly better than those did not use SBAR (median 9 vs. 4, p=<0.0001)

Calls using SBAR consistently significantly better across doctors and nurses and throughout the various grades.

A sizeable proportion of staff nurses did not use SBAR (44%) with the median rating of communication significantly lower (4) compared to when SBAR (7) was used (p=<0.0001).

Small sample size (n=65 telephone calls)

Only FY1 on-call observers to receive calls

Single Trust sample – difficult to extrapolate data to other trusts

Lack of data on quality of care/patient outcomes

Need for formal education programme

SBAR improved nurse-doctor communication leading to better documentation and fewer unexpected deaths1

SBAR improved ‘call impact’ in telephone from junior doctors and reduced the time taken to present the referral21De Meester K, Verspuy M, Monsieurs KG, Van Bogaert P. “ SBAR improves nurse-physician communication and reduces

unexpected death: A pre and post intervention study”. Resuscitation 2013 March 26 . http://dx.doi.org/10.1016/j.resuscitation.2013.03.016

2Cunningham NJ, Weiland TJ, van Dijk L, Paddle P, Shilkofski N, Cunningham NY. “Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting.” Postgrad Med J Nov;88!0145):619-26

All staff at Barnet and Chase Farm Hospitals NHS Trust particularly FY1 colleagues for their assistance in kindly rating calls and collecting data

Dr James Dooley