ISBAR: a tool for improving communication with patients

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ISBAR a tool for improving communication with
patients Creating better patient journeys
Improving patient experience
Dr Rosemary Aldrich
On behalf of Dr Kim Hill Professor Anne
Duggan Ms Kim Lane Professor Kichu Nair
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IntroductionSituationBackgroundAssessmentR
ecommendation
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Aim

• The ISBAR project aimed
• to develop and test a communication tool and
• ? to train HNE Health staff to use it
• ? to optimise clinical communication in
  inter-hospital transfer
• ? to effect improvements in the
  experience of patients and carers

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Nature and extent of the problem

• Director Clinical Governance established the HNE
  Health Clinical Communication Steering Group in
  2007
• Evaluation of incidents, complaints and
  international literature showed that
• poor communication was a common theme in
  patient complaints, serious adverse events and
  tragic experiences for patients, their carers and
  health care workers, and yet
• uptake of standardised communication systems
  was difficult to achieve
• ISBAR inter-hospital transfer project conceived
  early 2008 (funded by Australian Commission on
  Safety and Quality in Health Care)
• Project team established early (through surveys,
  focus groups and interviews) that many staff
  lacked confidence in their ability and skill to
  communicate effectively with patients, their
  carers and other staff

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Strategic importance

• The ISBAR project to improve communication in
  inter-hospital transfer addressed a priority area
  in patient care and safety
• We demonstrated that the ISBAR approach to
  communication improved the patient experience,
  was rapidly learnt by health professionals,
  improved the quality of clinical communication,
  and holds great promise in reducing incidents in
  which poor communication is a root cause

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Planning implementing solutions

• Led by an Executive Team and guided by a Project
  Steering Committee
• Informed by input from patients, carers,
  clinicians, managers and patient transport
  officers we adapted the ISBAR communication tool
  to improve clinical communication specifically
  concerning handover in inter-hospital transfer of
  patients and their care
• Trained staff to use the ISBAR format and
  recommended its use for communication with
  patients, carers and other staff
• Evaluated how staff training in ISBAR affected
  the quality of the communication experienced
  during 77 inter-hospital transfers by patients,
  carers, clinicians and other staff

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Outcomes evaluation

• More than 260 staff trained in ISBAR using a
  15-minute training program
• Achieved statistically significant improvements
  in self-reported confidence and skill in
  communicating effectively in clinical handover

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Shift in staff confidence and skill in handover
(n262)
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Outcomes evaluation

• More than 300 patients, carers and clinicians
  were interviewed about the 50 inter-hospital
  transfers which occurred after staff were trained
  
• Demonstrated improvements in patient and carer
  perceptions of quality of communication across
  seven elements, compared to baseline (before
  staff were trained in ISBAR)

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Patients perceptions of the quality of
communication with them before and after staff
were trained
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Outcomes evaluation

• Improved quality of documentation which
  accompanied the patient in key elements such as
  having a nursing summary, including test reports
  and documenting carers contact numbers for care
• Doubled frequency of documenting that the patient
  had been informed, although still much work to do
  

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Audit of patient files documentation relating to
inter-hospital transfer
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Lessons learned

• Patients, carers and staff know what they need to
  improve their experience of communication in
  health care ask them and involve them!
• A sustainable, memorable and useable tool to
  enhance communication can be learned in 15
  minutes, even if delivered opportunistically
• ISBAR serves all professional communication,
  including communicating with patients and their
  carers, escalating the deteriorating patient or
  effecting clinical handover

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Sustaining change

• Change became spontaneous and continues
• Tools made available, fielding constant requests
• ISBAR permeates all health communication in HNE
  Health even Executive Briefs
• A Communication Coalition is being established
  as part of two-year project aiming to ensure all
  staff are trained annually in and supported to
  use ISBAR routinely
• Making quality practice the usual practice is a
  key strategy of Clinical Governance in action

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Future scope

• Preliminary data suggest increased SAC 3 and 4
  incident reporting at target hospital
• Plan to evaluate incidents related to
  communication to determine whether using ISBAR
  across HNE Health leads to
• reduction in number and average severity of
  incidents
• reduction in SAC 1 incidents in which
  communication issues are nominated as a root
  cause
• Plan to evaluate confidence levels of staff in
  clinical communication

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Thank you

• Questions?

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