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Information transfer and communication during the morning rounds in surgical departments: an observational study on the use of SBAR.

Merten, H., Langelaan, M., Wagner, C. Information transfer and communication during the morning rounds in surgical departments: an observational study on the use of SBAR. Abstract. In: Abstractbook Poster presentations. International Society for Quality in Health Care (ISQUA) 30th International Conference 'Quality and safety in population health and healthcare'. Edinburgh: ISQUA, 2013. 346
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Objectives: To study the structure and completeness of the information transfer between nurses and physicians during the morning rounds on surgical wards after the implementation of the SBAR-communication tool. Methods: in collaboration with the care professionals, we adjusted the SBAR-tool (Situation, Background, Assessment, and Recommendation) for use in the participating surgical wards. The tool was implemented amongst the nurses of three surgical wards in Dutch hospitals. Presentations about the background and the use of the SBAR-tool were given, along with example cases. The nurses then received a pocket-size SBAR-card describing the relevant topics to discuss during the morning rounds. An observation protocol was developed to bserve the use of the SBAR-­tool during the morning rounds. The observation protocol consisted of two different parts; the first part was about the process of the morning rounds. To illustrate, information was collected on who takes the lead during the rounds and
whether the care professionals participating in the rounds gave their opinion about the suggested treatment. The second part of the observation protocol included the topics of the SBAR structure and whether they were discussed for each individual patient by the care professionals (physicians and nurses). Observations of the morning rounds were done approximately once a month on the three surgical wards from September 2008 until September 2009. Descriptive statistics were used to analyse the results. Results: In total, 43 morning rounds were observed in which 719 patients were discussed by the care professionals that participated in the rounds. The observations showed a substantial variation in the way the morning rounds were conducted between the hospitals, such as the average time per patient (range 2-21 minutes) and the performed tasks. There were also similarities; in 36 of the 43 rounds one of the care professionals took the lead, usually the ward physician or the surgical resident, never the nurse. In 30 rounds there were (almost) no interruptions. During 17 rounds the nurses asked questions regularly and the participants gave their unasked opinion regularly during six rounds. The results of the individual patient observations showed that all the elements and structure of SBAR were discussed and used for 20 patients (3%). The Situation was discussed for 86% of the patients, the Background or 58%, the Assessment for 73% and the Recommendations for 84% of the patients. The specific timeframe for a required action was addressed for 32% of the patients and for 5% the actions were reported back for confirmation. Conclusion: Although some elements of the SBAR were often discussed for individual patients by the care professionals, the SBAR structure was rarely used completely to structure the information transfer and communication between the nurses and the physicians. This finding may be explained by the existing differences between the three surgical wards, the force of habit during the morning rounds as well as the fact that the physicians rather than the nurses were leading the morning rounds.