Improving clinician-carer communication for safer hospital care: a study of the 'TOP 5' strategy in patients with dementia.
OBJECTIVE
To examine the impact of implementing a clinician-carer communication tool for hospitalized patients with dementia.


METHODS
Surveys were conducted with clinicians and carers about perceptions and experiences. Implementation process and costs were explored through surveys of local staff. Time series analysis was conducted on incident-reported falls, usage of non-regular anti-psychotics and one-to-one nursing.


METHODS
Twenty-one hospitals in Australia.


METHODS
Surveys were returned by 798 clinicians, 240 carers and 21 local liaison staff involved in implementation.


METHODS
Implementation of a communication tool over 12 months.


METHODS
The process of implementation was documented. Outcome measures included clinician and carer perceptions, safety indicators (incident-reported falls and usage of non-regular anti-psychotics), resource use and costs.


RESULTS
Clinicians and carers reported high levels of acceptability and perceived benefits for patients. Clinicians rated confidence in caring for patients with dementia as being significantly higher after the introduction of TOP 5, (M = 2.93, SD = 0.65), than prior to TOP 5 (M = 2.74, SD = 0.75); F(1,712) = 11.21, P < 0.05. When analysed together, there was no change in incident-reported falls across all hospitals. At one hospital with a matched control ward, an average of 6.85 fewer falls incidents per month occurred in the intervention ward compared with the matched control ward (B = -6.85, P < 0.05).


CONCLUSIONS
Our findings indicate that the use of a simple, low-cost communication strategy for patient care is associated with improvements in clinician and carer experience with potential implications for patient safety. Minimally, TOP 5 represents 'good practice' with a low risk of harm for patients.
Clinical Excellence Commission, Sydney, NSW, Australia.
Karen
K
Luxford
Clinical Excellence Commission, Sydney, NSW, Australia.
Anne
A
Axam
Clinical Excellence Commission, Sydney, NSW, Australia.
Fiona
F
Hasnip
Central Coast Local Health District, Mental Health Service for Older People, Central Coast, NSW, Australia.
John
J
Dobrohotoff
Central Coast Local Health District, Carer Support, Central Coast, NSW, Australia.
Maureen
M
Strudwick
Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia.
Rebecca
R
Reeve
Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia.
Changhao
C
Hou
Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia.
Rosalie
R
Viney
D000058:Accidental Falls / Q000517:prevention & control; D014150:Antipsychotic Agents / Q000008:administration & dosage; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D003258:Consumer Behavior; D003704:Dementia / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006739:Hospital Administration; D006801:Humans; D007318:Inservice Training; D008297:Male; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D010465:Perception; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care
D014150:Antipsychotic Agents
carers; communication; dementia; hospital care; patient safety; survey