Abstract
Background:
Long-term adherence to bedside report (BSR) in the ICU is difficult to achieve for many respiratory departments. BSR has shown to improve: patient safety and staff accountability, prioritizing workload, communication with multidisciplinary team, opportunity to ask off going RCP questions while observing patients, and feeling more aware of patients’ issues. BSR studies are nursing-centric with a dearth of RCP focused research. The UC Davis Health, Respiratory Care leadership team set forth to create a positive culture change for BSR through administrative support, education, resolution of barriers, and sustained adherence.
Methods:
An investigator-developed Quality Report Survey (QRS) was given to a convenience sample of n=34 RCP staff to determine the perception of need for BSR pre-pilot change. Literature review education, barriers addressed, and instructions on how to perform BSR was given by a shift supervisor following the QRS survey; standardized report elements established in current policy. BSR was initiated in two of nine ICUs: MICU and NICU. Portable EMR carts and clipboards provided to each ICU. RCP Leadership conducted shift-change rounding in pilot units to remind/support staff from initiation to the third month. Audit for adherence via anonymous surveillance with n=56 observations performed during the fourth month. Investigator-developed BSR Feedback Survey (FBS) given to a convenience sample of n=34 at month seven.
Results:
QRS with a four-point Likert scale determined a moderately-severe need for BSR. The anonymous adherence surveillance resulted in MICU performing BSR 50% of 30 observations; NICU resulted in 65% of 26 observations. BSR FBS questionnaire showed 80% of those that self-reported to have performed BSR ≥10 times found BSR beneficial. Forty-six percent found BSR beneficial of those that self-reported to have performed BSR 0-9 times. Fifty percent of staff had at least one instance of BSR helping to answer patient care questions from oncoming RCP. Sixty-two percent of staff experienced patient condition changed from previously visualizing patient at least once when performing BSR. Seventy-four percent of staff received or gave helpful information to other multidisciplinary team members during BSR.
Conclusions:
Overall adherence of 57% in the pilot ICUs, as well as 63% of surveyed staff found BSR to be beneficial. Diligent administrative report, education, resolution of barriers, and surveillance of adherence provided improved outcomes in RCP staff performing BSR.
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