A Novel ICU Hand-Over Tool: The Glass Door of the Patient Room.
BACKGROUND
Poor communication among health-care providers is cited as the most common cause of sentinel events involving patients. Patient care in the critical care setting is incredibly complex. A consistent care plan is necessary between day/night shift teams and among bedside intensive care unit (ICU) nurses, consultants, and physicians. Our goal was to create a novel, easily accessible communication device to improve ICU patient care.


METHODS
This communication improvement project was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 214 admissions per month. We created a glass door template embossed on the glass that included 3 columns for daily goals to be written: "day team," "night team," and "surgery/consultant team." Assigned areas for tracking "lines," "antibiotics," "ventilator weaning," and "Deep vein thrombosis (DVT) screening" were included. These doors are filled out/updated throughout the day by all of the ICU providers. All services can review current plans/active issues while evaluating the patient at the bedside. Patient-identifying data are not included. We retrospectively reviewed all ICU safety reported events over a 4-year period (2 years prior/2 years after glass door implementation) for specific handover communication-related errors and compared the 2 cohorts.


RESULTS
Information on the glass doors is entered daily on rounds by all services. Prior to implementation, 7.96% of reported errors were related to patient handover communication errors. The post glass-door era had 4.26% of reported errors related to patient handover communication errors with a relative risk reduction of 46.5%. Due to its usefulness, this method of communication was quickly adopted by the other critical care services (cardiothoracic, medical, neurology/neurosurgery, cardiology) at our institution and is now used for over 150 ICU beds.


CONCLUSIONS
Our glass door patient handover tool is an easily adaptable intervention that has improved communication leading to an overall decrease in the number of handover communication errors.
1 Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.|2 Division of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Brian T
BT
Wessman
3 Department of Nursing, Barnes-Jewish Hospital, St. Louis, MO, USA.
Carrie
C
Sona
4 Department of Research for Patient Care Services, Barnes-Jewish Hospital, St. Louis, MO, USA.
Marilyn
M
Schallom
D057189:Checklist; D003142:Communication; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D019300:Medical Errors / Q000517:prevention & control*; D062209:Patient Handoff / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies
ICU; checklist; communication; multidisciplinary critical care; organization; patient handover