IMPLEMENTING AN SBAR COMMUNICATION PROTOCOL: A QUALITY IMPROVEMENT PROJECT

Purpose: A quality improvement project implemented a systematic method for nurses to collect and communicate data pertaining to change in resident health status. The primary aim was to improve the communication between nurses and primary care providers (nurse practitioners and physicians) and reduce the incidence of avoidable hospital transfers of nursing home residents.

Rationale/Background:  Primary care providers and nurses both acknowledge that a combination of communication issues with nurses results in avoidable, unnecessary hospitalizations of nursing home residents, placing them at risk for dangerous and costly complications. The timing, clarity, and content of information, as well as the nurse's ability to synthesize and communicate key clinical information to the primary care provider are key determinants to these outcomes.

Methods: Utilizing Kotter's Theory of Change, a quality improvement project with a pre/post evaluation was implemented in a 137-bed skilled nursing facility, part of a faith-based continuing retirement community in rural Pennsylvania. An SBAR Communication Protocol was implemented over a 4-month period containing the following components: (1) A systematic method for nurses to collect data and communicate (SBAR technique); (2) nurse training on SBAR; (3) training of medical providers on SBAR; and (4) systematic evaluation of unplanned hospital transfers integrated into quality improvement activity. Primary care satisfaction with communication was evaluated through a semi-structured questionnaire to assess satisfaction with SBAR implementation. The rate of unplanned hospital transfers was evaluated by the nursing home's medical director bi-weekly to track and trend avoidable hospitalizations Nurses' compliance with completing the SBAR tool was tracked and trended.

Outcomes: SBAR utilization was associated with a trend toward fewer overall unplanned hospital transfers, fewer 30-day readmissions to the hospital, and more transfers avoided. Medical providers reported improved satisfaction with communication, improved consistency in data conveyed regarding resident change in status, and a view that information conveyed influences decision-making regarding hospitalizations.

Conclusions: SBAR methodology offers a viable approach to preventing avoidable hospitalization of nursing home residents and improving clinician satisfaction. This project's design can be easily implemented in any long-term care facility as part of the quality improvement process.