Quality care often hinges on effective communication with patients and loved ones engaged in their care. But in a high-stress environment such as the intensive care unit (ICU), it can be a difficult and daunting task for some patients to articulate their needs and assume an active, collaborative role in their care plans.

Patricia Dykes, PhD, RN, a senior nurse scientist in the Center for Patient Safety, Research and Practice and the Center for Nursing Excellence, is lead author on a paper published in the August issue of Critical Care Medicine that describes how to improve communication in the ICU through the use of web-based tools.

Using an approach called PROSPECT (Promoting Respect and Ongoing Safety through Patient Engagement Communication and Technology), Dykes and her team implemented a safety checklist with real-time data from patients’ electronic health records (EHRs) that providers review during patient rounds. In addition to the checklist, there is also a messaging platform for patient and care team communication, as well as an online portal where patients can input feedback on their care plan. Patients who could give informed consent (or their proxy) were given access to the portal through a hospital-issued iPad by their bedside, encouraging them to engage in development of their care plan.

Clinicians involved with the intervention in two ICUs were trained in patient-centered care and engagement and learned how to use the web-based tools. The researchers compared patients’ experience and outcomes before and after the intervention. The team studied both patients and their “care partners” – family and friends involved in the patient’s care.

The results were encouraging – adverse events fell by 29 percent, driven primarily by a drop in catheter-associated urinary tract infections and pressure ulcers. Additionally, the researchers observed improvements in both patient and care partner satisfaction scores. Surveys measured each party’s overall satisfaction with care provided before and after the intervention, as well as specific elements of care, such as staff responsiveness and decision-making processes.

Participants in the study praised the initiative for empowering patients and their families with better tools for communicating with care teams and accessing information about quality and safety.

Although researchers were unable to determine which specific tools accounted for the improvements, they believe daily use of the electronic checklists (instead of paper safety checklists) played an important role.

“Using web-based technology to enhance tools such as the ICU safety checklists has a meaningful impact on improving care quality,” said Dykes. “With updated, patient-specific information pulled from patient EHRs, clinicians can make more informed decisions. As the checklists are reviewed daily, frontline providers become more focused on the patient’s care plan, routinely asking and addressing the care preferences and goals of the patients, enabling patients to better engage in their care.”

Based on their preliminary results, the team plans to expand the use of the web-based checklist to other ICUs in BWH and Brigham and Women’s Faulkner Hospital.

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