Date of Graduation

Fall 12-17-2017

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Abstract

This Clinical Nurse Leader (CNL) quality improvement project aims to improve the consistency of intradepartmental communication between Urgent Care Center (UCC) staff, through standardized SBAR patient hand-offs. The aim is to improve; (1) the consistency and clarity of patient hand-offs, (2) staff experience and satisfaction with communication during hand-offs, and (3) prevent adverse patient outcomes resulting from poor communication. As a safety net hospital, traditionally serving a predominately underserved, and underinsured, multicultural demographic, the UCC is designed to alleviate the Emergency Department (ED) of non-emergent patient encounters, providing a cost effective alternative, whilst adhering to Emergency Medical Treatment and Labor Act (EMTALA) provider medical screening (MSE) requirements. A microsystem assessment incorporating staff and Agency for Healthcare Research and Quality (AHRQ) surveys, in addition to observational data, indicated a need for communication improvement. Lewin’s three step theory of change was applied in formulating an educational program to address current communication concerns, explore the benefits of the SBAR communication in an urgent care setting, and applicability in UCC scenarios, with patient hand-off observations, and subsequent observations at 3 and 6 weeks. Preliminary PDSA (n=4) cycles indicated SBAR knowledge increased by 36%, SBAR use by 50%, ability to explain SBAR by 18% and the belief SBAR keeps information organized by 15%. Issues of observational data validity will be addressed in the subsequent PDSA cycles.

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