Background: Non-emergent communications between nursing staff and covering providers often occur randomly throughout the workday at teaching institutions, resulting in inefficiency and interruptions of scheduled resident educational conferences or periods of overnight rest.
Methods: We conducted a prospective, mixed-methods, crossover trial of a communication strategy between nurses and residents in 3 neurology units of a single academic institution. We measured content and volume of notifications from nurses to residents during scheduled conferences and overnight, and categorized these notifications according to levels of urgency. We implemented an intervention requiring evening work rounds between the on-call provider and charge nurse, and batching of non-emergent communications. Survey data were collected to determine perceived safety, utility, and satisfaction of the intervention.
Results: The total census during the 6-month study period was 728 patients with a mean case-mix index of 1.86 (indicating moderate disease complexity). Of the total 704 provider-reported nursing notifications, there was a 56.3% decrement of notifications in the post-intervention period. Of the total 299 nurse-reported notifications, there was a 46.9% decrement in the post-intervention period. Both nurses and residents provided more favorable survey responses in the post-intervention period across multiple items that addressed patient safety, utility, and satisfaction (p<0.01 for comparisons).
Conclusions: A scheduled nurse-resident communication system reduced interruptive calls during educational conferences and overnight by half. This intervention was safe, effective, and resulted in higher satisfaction among nurses and residents.