Wednesday, May 16, 2012

Caring = f(Σ4.5seconds x constant)

Dr. Susan Shaw, a critical care doctor in Saskatoon, decided to conduct a clinical trial.  For this one, though, she used the Lean PDSA cycle:  Plan, Do, Study, Act.  It required no IRB approval and could be replicated by any doctor out there.

What was this?  She was inspired by Liz Crocker's talk at the provincial Health Care Quality Summit a few months ago, and also by a story told by Bonnie Brossart.  She wondered how much time it would add to her work day, and what would be the results, if she asked each patient a question.

Her summary of the trial was recently posted:

Plan: For one week, at the end of each bedside round, ask the patient and/or the family “Is there anything else I can do for you today?”

: Do and describe what happened. I chose the following measures: how much time asking and answering the question took, how many yes’s how many no’s and what additional questions and requests were asked.

: Analyze the results and determine what you learned.

: Adapt, adopt, or abandon the change based on what you learned. Then complete the cycle testing out another small change.

Here is a description of the protocol employed:

I didn’t use any fancy data collection tools. Just a pen and a piece of paper that I carried in my back pocket, along with some additional attention paid to the clock on the wall. And I wrote down the answers to my question, which I asked 87 times over the course of one week.

And, finally, the results:

What did I discover?  Asking “Is there anything else I can do for you today?” added an average of 4.5 seconds to the length of the time I spent rounding with each patient

Asking this important question did not slow me or my team down. I did not get asked any difficult or awkward questions. I felt like I made a stronger connection with the patients and families in the ICU. And I liked that this simple question provided a sense of closure to the round while signaling to the patient and family that we truly were interested in helping and supporting them.

I also smiled a big smile when I overheard two of the four residents working with me that week asking the same question of nurses, patients, and families when they were working at the patient’s bedside.

1 comment:

Dr.Theresa Willett said...

I love this! Just as we so often complain that there is not way to 'measure' components of care, here is a clever and simple way to do so.
The biggest plus is that she was leading by example. So many times the level of attention to care/communication/etc that an attending doctor shows on rounds quickly trickles into the resident behaviors.
Unfortunately, more often than not in my experience, this led to poor communication with PCPs and a sense that it was 'scut work' not sexy enough to warrant the attending's (thus resident's) time.
Care of the patient and the entire health care team needs more than lip service, so kudos to Dr. Shaw!