Improving communication and patient outcomes with SBAR at a skilled nursing facility: a quality improvement project
Westphal, Mackenzie Sue
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Background: Improving patient outcomes depends on high-quality communication among healthcare providers. The aim of this project is to improve communication between geriatric providers and a skilled nursing facility during after-hour phone calls. Local Problem: Geriatric providers expressed concerns about inadequate communication during after-hours phone calls from a Medicare-Medicaid-certified skilled nursing facility. Methods: This quality improvement project utilized the Plan-Do-Study-Act method to create sustainable change. Communication was quantified by establishing 11 key elements of SBAR created based on the Agency for Healthcare Quality and Research TeamSTEPPS curriculum and provider preferences. A needs assessment was conducted to determine baseline data and identify gaps in communication. Phone audits and surveys were used to collect data. Interventions: The Agency for Healthcare Quality and Research's TeamSTEPPS curriculum provided the foundation to create a facility specific SBAR training for staff. The inperson training included a presentation, sample SBAR reports, and resources to reference. Results: The SBAR training at the skilled nursing facility resulted in 10% increase in average SBAR components reported to providers. There was an increase in SBAR elements reported in the Situation, Assessment, and Recommendation categories. There was not a significant change in provider satisfaction, staff satisfaction, or staff confidence. Several residents were unnecessarily transferred to the hospital and received interventions that could have been performed at the facility. Conclusions: SBAR can improve communication between geriatric providers and nursing staff during after-hour calls. Improving communication in skilled nursing facilities is vital to quality patient outcomes and reducing preventable hospitalizations.