Date of Graduation

Fall 12-17-2021

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Executive Leader DNP

First Advisor

Dr. Mary Lynne Knighten

Second Advisor

Dr. Elena Capella

Abstract

Background: Communication has become a key performance measure in the shift to value-based healthcare. Given the impact of communication failures on patient harm, length of stay, and dissatisfaction with care, new models of care with better communication through structured teamwork and interdisciplinary collaboration are needed.

Problem: In a 16-bed geriatric medical/surgical unit of a New York City multispecialty community hospital, the workflow structure unintentionally created inconsistent handoff communication, gaps in continuity of care, missed care events, and inattention to the patient’s priorities in the care plan. A gap analysis identified communication deficiencies that impacted team effectiveness and patient care outcomes.

Methods: Patient perceptions of care and staff perceptions of teamwork were assessed pre-and post-intervention for the effects of implementing structured team communication in a nurse practitioner (NP) medical management model. Responses were collected with the NRC Health Patient Experience Survey and the AHRQ TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ). Patient experience scores for the NP-led unit, a resident-led unit, and a physician-assistant led unit were compared.

Interventions: Implementation of an NP-Led Care Pod model was evaluated over three months. An education session on structured communication tools prepared NP-Led Care Pod teams in role-based purposeful rounds, bedside shift reports, structured bedside interdisciplinary team rounds, and TeamSTEPPScommunication strategies.

Results: Teamwork perception scores post-education and post-implementation fell short of the aim for a 10% increase from baseline. Patient experience survey scores increased 71.6% from baseline at two months for care team explanations, 128% for listening carefully, and 71.6% for perceived staff communication. Although not sustained, all scores were 14% higher than baseline. Team members reported increased team support, inclusion, and role satisfaction. Patients asked fewer questions about their care plans.

Conclusion: The NP-Led Care Pods contributed to evidence on the effectiveness of NP-led, team-based care, with implications for nursing leadership and team communication. The NP-Led Care Pod environment improved workflow, team dynamics, and staff communication. Further studies may benefit from using measures to capture improvement in patient safety and patient experience domains that were not addressed in this project.

Keywords: acute care nursing, bedside handoff, collaboration, communication, interprofessional, patient-centered care, purposeful rounding, team perceptions, TeamSTEPPS.

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