Category: Health Policy and Systems
Inadequate communication between nurses and physicians frequently leads to suboptimal patient care. One significant example is the mismanagement of neurogenic bowel in patients with brain injury, which can lead to serious complications including delirium, fecal impaction, increased LOS, and increased morbidity/mortality.
In 2017 over a three-month period, we found that a majority of patients admitted to the brain injury unit had been constipated during their inpatient rehabilitation. Twenty-six patients with TBI, SDH, SAH, or ICH admitted into our in-patient rehabilitation unit were reviewed. 21 of 26 patients (76%) had less than one bowel movement every other day. 19 out of 26 (70%) had less than three bowel movements per week. We considered multiple factors that may impact the execution and follow up of constipation management and a quality improvement project was initiated: standardized physician and nurse rounding to include a communication tool on bowel habits and regimens. Our aim for this quality improvement project was for 50% of all traumatic brain injury patients admitted in the brain injury unit to have a bowel movement at least three times per week.
Since the standardization of the nurse and physician rounding, we achieved our aim of at least 50% of our traumatic brain injury patients having bowel movements at least three times per week. The number of patients achieving this went from 30% before the implementation of standardized nurse and physician rounding, to 95% after this implementation for a total increase of 65%.
Fractured communication between physicians and nursing leads to issues in many aspects of patient care. By implementing a standardized communication tool for our daily nurse and physician rounds, we improved quality outcomes and patient care. Daily nurse and physician rounding with a standardized communication tool may continue to improve the quality of care among other patient populations as well.