PM2063: Night Rounds: Pediatric Residents and Nurses Partner to Improve Night Team Communication

Purpose/Objectives: The majority of adverse outcomes in medicine are due to communication breakdown. A prior study demonstrated that implementation of standardized interdisciplinary “Night Talks” significantly decreased near misses on neurosurgical patients. At our institution, there is no standardized nighttime communication between care team members on the medical-surgical floor. In a needs assessment, the majority of night shift nurses perceived physician-nursing communication to be fair or poor, with less in-person interactions at night than during the day. This survey inspired a resident and nursing collaborative initiative - “Night Rounds” - to improve communication. This study aims to improve rates of night rounding on the inpatient unit to 90% over a 13-month time period.

Design/Methods: Observational time series with multiple planned sequential interventions were carried out by an interprofessional resident- and nursing-led quality improvement team utilizing a key driver diagram (Figure 1) as a contextual framework. During the study period (January 2021 to February 2022), medical-surgical nursing teams completed a “Night Rounds” checklist each night to track rounding by each resident team and concerns addressed. Surveys were completed by residents and nursing before and during the study period to assess the qualitative effectiveness of night rounding. Statistical process control P charts were used to display weekly rates of night rounding and topics discussed. Established rules for detecting special cause variation were applied.

Results: During the study period, the average rate of night rounding improved from 37.5% to 95.1% (Figure 2). Initial success was not sustained after a change in attending staffing and additional ongoing barriers. Subsequent special cause variation showed sustained performance above the goal. Per ongoing nursing surveys, nursing concerns (addressed in 33.4% of night rounds), parental concerns (13.9%), data abnormalities (15.1%), contingency plans (17.8%), and order changes (19.6%) were addressed. The self-reported percentage of residents who always/almost always communicated plan of care changes to nursing increased from 39.3% to 65.8%. Residents reported a decrease in pages received from 53% to 36.8%.

Conclusion/Discussion: Keys to success included interprofessional collaboration between nursing and residents. An existing safety culture promoted a space for nursing to voice concerns and for residents to establish and maintain a shared mental model throughout day and night shifts. The standardized process and format for Night Rounds was integrated into existing workflows. Challenges included a hospital-wide EMR transition, a change in hospitalist attending staffing, and project leader fellowship application obligations impacting consistent data collection and rotating night team resident engagement. Next steps include correlating the impact of Night Rounds on emergent transfers and parent/caregiver perceptions of night team communication.