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  1. Lindsey Justice1,
  2. David Cooper1,
  3. Carla Henderson2,
  4. James Brown1,
  5. Katie Simon1,
  6. Lindsey Clark1,
  7. Elizabeth Fleckenstein1,
  8. Alexis Ramby1,
  9. David Nelson1
  1. 1Cincinnati Children's Hospital Medical Center (CCHMC), United States
  2. 2University of Cincinnati College of Nursing, United States


Background The care of critically ill children in intensive care units (ICU) has become increasingly complex. Utilization of multidisciplinary care teams leads to reduction in mortality and length of stay, prevention of adverse events, and improvement in quality of care. However, as the number of care providers grows and patient demand increases, coordination of multidisciplinary care becomes more complicated.

Objectives To improve communication during cardiac ICU multidisciplinary rounds.

Methods Quality improvement methodology was utilized to evaluate implementation of a daily patient goal write-down/read-back process. The Rounds Effectiveness Assessment and Communication Tool (REACT) was developed, based on the previously validated Patient Knowledge Assessment Tool (PKAT), to evaluate comprehension of patient daily goals during multiple PDSAs (Plan, Do, Study, Act). Rounds were assessed for each patient by the bedside nurse, nurse practitioner or fellow, and attending physician, and answers were compared to determine percent agreement per day.

Results Baseline percent agreement for patient goals was 62%. After intervention, percent agreement improved to 85%. Family satisfaction with rounds was assessed using a 1–6 Likert scale and improved from a mean of 4.6 to 5.7. Parent selection of the best possible score for each question was 19% at baseline and 75% after the intervention.

Conclusions Visual display of patient daily goals via a write-down/read-back process improves comprehension of goals by all team members and improves parent satisfaction. The daily goals whiteboard facilitates consistent development of a comprehensive plan of care for each patient, fosters goal-directed care, and provides a checklist for providers and parents to review throughout the day.

Figure 1

Rounds Effectiveness Assessment and Collaboration Tool.

Figure 2

Parent Satisfaction Survey.

Figure 3

REACT Results-Percent Matching Responses Per Day.

Figure 6

Family Survey Results-Family survey results improved for every question, and the overall mean score improved from 4.6 to 5.7 out of 6.

Table 1

Summary of PDSAs.

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