Plan of Care Whiteboards Post 2: Improving Satisfaction and Length of Stay at Riley Hospital for Children

February, 2014

Nurses in the PICU at Riley Hospital for Children are dedicated to their work.  They take care of some of the sickest kids, and try to provide comfort and support to parents and families as well.  But despite their best efforts, survey scores for parents’ trust in ICU nurses, feeling nurses explained clearly, and believing they had enough input into their child’s care were only in the mid-seventies (for percent always).

Knowing how important communication and trust are to parents of PICU patients, three experienced PICU nurses applied for and received a grant from the AACN and devised a solution to improve plan of care communication.  They combed evidence-based best practices, conducted an appreciative inquiry with a high-performing unit within their hospital, spoke with fellow care team members, and tapped into the expertise of their Parents as Faculty program to get a clear patient/family perspective.  The solution they created built on their existing multi-disciplinary rounds (MDR) program in three ways:

1. Explain MDRs within 24 hours of admission to help set expectations.
2. Engaging family at the bedside before rounds, and conducting a teach-back session after rounds (asking parents to explain what they heard, and redirecting if there are any misunderstandings).
3. Recording daily goals and goals to transfer to a general medical unit on the whiteboard.

To implement the change, the three program leaders conducted a kick-off event, held small group trainings, and audited the use of the goal-driven whiteboard components, allowing them to celebrate success and troubleshoot as needed.

Over the course of the project, the new approach to family communication resulted in improvement in scores for all three of the domains tested – confidence and trust in ICU nurses rose from 75% to 88% (percent Always), nurses explaining clearly jumped from 78% to 98%, and having enough input into the child’s plan of care went from 74% – 86%.  In addition, average length of stay in the PICU dropped by a full day, resulting in substantial cost savings.

We applaud the grassroots efforts and peer passion of the three nurses leading this transformation: Terri Bogue, RN, BSN, CPN Quality Outcomes Coordinator, Connie Neuzerling, RN, BSN, Senior Partner, CVS Clinical Program Specialty Coordinator, and Susan Willock, RN, BS, BSN, MEd, CCRN, Senior Partner, Clinical Specialty Coordinator.  Ms. Bogue told members of the Experience Innovation Network on a recent webinar describing the initiative, “Bedside nurses tend to have fabulous ideas.”  We couldn’t agree more!