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ISBAR: a tool for improving communication with patients

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Title: ISBAR: a tool for improving communication with patients


1
ISBAR a tool for improving communication with
patients Creating better patient journeys
Improving patient experience
Dr Rosemary Aldrich
On behalf of Dr Kim Hill Professor Anne
Duggan Ms Kim Lane Professor Kichu Nair
2
IntroductionSituationBackgroundAssessmentR
ecommendation
1
3
Aim
  • The ISBAR project aimed
  • to develop and test a communication tool and
  • ? to train HNE Health staff to use it
  • ? to optimise clinical communication in
    inter-hospital transfer
  • ? to effect improvements in the
    experience of patients and carers

4
Nature and extent of the problem
  • Director Clinical Governance established the HNE
    Health Clinical Communication Steering Group in
    2007
  • Evaluation of incidents, complaints and
    international literature showed that
  • poor communication was a common theme in
    patient complaints, serious adverse events and
    tragic experiences for patients, their carers and
    health care workers, and yet
  • uptake of standardised communication systems
    was difficult to achieve
  • ISBAR inter-hospital transfer project conceived
    early 2008 (funded by Australian Commission on
    Safety and Quality in Health Care)
  • Project team established early (through surveys,
    focus groups and interviews) that many staff
    lacked confidence in their ability and skill to
    communicate effectively with patients, their
    carers and other staff

5
Strategic importance
  • The ISBAR project to improve communication in
    inter-hospital transfer addressed a priority area
    in patient care and safety
  • We demonstrated that the ISBAR approach to
    communication improved the patient experience,
    was rapidly learnt by health professionals,
    improved the quality of clinical communication,
    and holds great promise in reducing incidents in
    which poor communication is a root cause

6
Planning implementing solutions
  • Led by an Executive Team and guided by a Project
    Steering Committee
  • Informed by input from patients, carers,
    clinicians, managers and patient transport
    officers we adapted the ISBAR communication tool
    to improve clinical communication specifically
    concerning handover in inter-hospital transfer of
    patients and their care
  • Trained staff to use the ISBAR format and
    recommended its use for communication with
    patients, carers and other staff
  • Evaluated how staff training in ISBAR affected
    the quality of the communication experienced
    during 77 inter-hospital transfers by patients,
    carers, clinicians and other staff

7
Outcomes evaluation
  • More than 260 staff trained in ISBAR using a
    15-minute training program
  • Achieved statistically significant improvements
    in self-reported confidence and skill in
    communicating effectively in clinical handover

8
Shift in staff confidence and skill in handover
(n262)
9
Outcomes evaluation
  • More than 300 patients, carers and clinicians
    were interviewed about the 50 inter-hospital
    transfers which occurred after staff were trained
  • Demonstrated improvements in patient and carer
    perceptions of quality of communication across
    seven elements, compared to baseline (before
    staff were trained in ISBAR)

8
10
Patients perceptions of the quality of
communication with them before and after staff
were trained
11
Outcomes evaluation
  • Improved quality of documentation which
    accompanied the patient in key elements such as
    having a nursing summary, including test reports
    and documenting carers contact numbers for care
  • Doubled frequency of documenting that the patient
    had been informed, although still much work to do

10
12
Audit of patient files documentation relating to
inter-hospital transfer
13
Lessons learned
  • Patients, carers and staff know what they need to
    improve their experience of communication in
    health care ask them and involve them!
  • A sustainable, memorable and useable tool to
    enhance communication can be learned in 15
    minutes, even if delivered opportunistically
  • ISBAR serves all professional communication,
    including communicating with patients and their
    carers, escalating the deteriorating patient or
    effecting clinical handover

14
Sustaining change
  • Change became spontaneous and continues
  • Tools made available, fielding constant requests
  • ISBAR permeates all health communication in HNE
    Health even Executive Briefs
  • A Communication Coalition is being established
    as part of two-year project aiming to ensure all
    staff are trained annually in and supported to
    use ISBAR routinely
  • Making quality practice the usual practice is a
    key strategy of Clinical Governance in action

15
14
16
Future scope
  • Preliminary data suggest increased SAC 3 and 4
    incident reporting at target hospital
  • Plan to evaluate incidents related to
    communication to determine whether using ISBAR
    across HNE Health leads to
  • reduction in number and average severity of
    incidents
  • reduction in SAC 1 incidents in which
    communication issues are nominated as a root
    cause
  • Plan to evaluate confidence levels of staff in
    clinical communication

17
Thank you
  • Questions?

16
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