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Improving Communication Between Nurses and Resident Physicians

A 3-Year Quality Improvement Project

Smith, Heather, MD; Greenberg, Joshua, MD, MSc, FRCSC; Yeh, Shang-Yee, MD, FRCSC; Williams, Lara, MD, MSc, FRCSC; Moloo, Husein, MD, MSc, FRCSC

doi: 10.1097/QMH.0000000000000192
Quality Improvement

Breakdown in communication is a predictor of both nursing and surgical errors. In a 2013 survey at our institution, staff on the general surgery unit identified nurse-resident communication as the most important issue related to patient safety. The general surgery Comprehensive Unit-based Safety Program sought to improve nurse-resident communication through a 3-year quality improvement initiative. A multidisciplinary working group conducted a root-cause analysis and developed initiatives addressing priority issues in nurse-resident communication. Two main interventions were developed: structured face-to-face interaction at discharge rounds and notebooks to transfer nonurgent messages. Compliance was evaluated. The primary outcomes of percieved communication and collaboration were assessed using a validated survey distributed to residents and unit nurses before the intervention, 9 months after, and 2.5 years after the intervention. The interventions were associated with improvements in perceived communication and team function. Survey scores, on average, were significant higher at 9 months postintervention and remained significant compared with preintervention after 2.5 years (from 57% to 74%, P = .01, then 72%, P = .02, among residents; and from 63% to 80%, P = .01, then 77% among nurses). Our framework and initiatives addressing nurse-resident communication may be useful for other teams interested in addressing this critical patient safety issue.

Division of General Surgery, The Ottawa Hospital in Ottawa, Ontario, Canada (Drs Smith, Greenberg, Yeh, Williams, and Moloo); and Ottawa Hospital Research Institute, The Ottawa Hospital in Ottawa, Ontario, Canada (Dr Moloo).

Correspondence: Husein Moloo, MD, MSc, FRCSC, The Ottawa Hospital 797 Parkdale Ave, Ottawa, ON, K1Y1J8, Canada (

This study was approved as a quality improvement initiative by the Hospital Research Ethics Board, and therefore no formal ethics review was required as per standard operating procedure section

The authors declare no conflict of interest.

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