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Abstract
Retention of medical information is often poor, especially when patients or parents are anxious. Patients often focus on diagnosis-related information and fail to register instructions on treatment. Retention is improved with written information.
Patient experience feedback was collected using visual aids to engage patients. Communication was highlighted as an area for improvement.
We present the use of bedside patient-led Communication (Comms) charts to improve communication between patients, parents and staff. This tool was implemented on a district general hospital Paediatric Ward with 15 inpatient beds. (See Figure 1).
The ‘Comms Charts’ were ‘co-designed’ by patients, medical professionals, play therapists and a hospital schoolteacher. ‘Co-design’ is a process where health-care professionals work in partnership with service-users. Evidence suggests this can produce sustainable, cost-effective improvements.
The ‘Comms Charts’ incorporated patient and parent-prioritised information. The tools were designed in a gender-neutral and child friendly layout. Information included: ‘I want to be called’, ‘facts about me’, ‘today I’m going to (goals)’, ‘I’m aiming to go home’, and ‘questions I want to ask’.
Staff received training regarding the use of this tool. All members of the multidisciplinary team were responsible for updating and reviewing the ‘Comms Charts.’ Staff were encouraged to incorporate this process into daily routine. Champions were identified to improve sustainability of this tool. Patients were provided with whiteboard pens and the laminated sheets could be re-used.
The ‘Comms Charts’ were implemented over a 3 month period. The intervention was assessed via quantitative and qualitative feedback to assess acceptability and feasibility. Staff were surveyed pre and post-intervention using a questionnaire. 11 of 15 healthcare professionals surveyed (73%) believed communication needed to be improved pre-intervention. Following intervention, 14 of 21 surveyed (67%) believed communication had improved. 18 of 21 surveyed (86%) stated it was an effective tool to aid communication, and 1 of 21 (5%) thought it led to excessive work. 18 of 21 surveyed (86%) believed it served as a useful prompt for on-going evaluation of patient’s healthcare.
Qualitative data was collected from parents, patients and staff via semi-structured interviews. Staff included Doctors, Nurses, Physiotherapists, Play therapists and a School Teacher. Informed consent was obtained. Recurring themes highlighted on thematic analysis included: Improvements to information sharing and communication, and breaking down of barriers.
Improved communication “It was very useful, I was able to mention my concerns and worries. We discussed and wrote the questions which were in my mind. Excellent idea” (Parent)
“it can be a very useful tool for communication with all team members and family” (Physiotherapist)
“Patients have appreciated them” (Teacher)
Breaking down barriers “They make me feel welcome and at ease. I have gained more information about my care and condition” (Patient)
“They are a good way of keeping track of where we are up to. It’s nice to have some personal information about the children taken” (Parent)
“I think the sheets are useful as it could make someone happy/make them laugh by using your nickname” (Patient)
Improvements and Strategy for change Feedback was incorporated into a Plan Do Study Act (PDSA) cycle to continue to ensure sustainability. One barrier highlighted was the workload for staff updating on ward-rounds when busy.
“The practical implications of doing it during a busy ward round can be tricky” (Doctor)
Following this feedback, the model was adjusted. Play therapists were integrated as Champions to prompt the children to update the ‘Comms Charts’ before ward rounds reducing medical staff workload. Following adjustment of the process there was increased medical professional acceptability.
Message to others/Summary Our findings suggest that white boards are a potential tool for improving communication and multidisciplinary teamwork. Further research is needed to determine sustainability of this tool.