“Covering provider”: an effort to streamline clinical communication chaos

• Published in: JAMIA open 2024-10, Vol.7 (3), p.ooae057
• Main Authors: Joshi, Mugdha, Gokhale, Arjun, Ma, Stephen, Pendrey, Anna, Wozniak, Lauren, Moturu, Anoosha, Schwartz, Nicholas U, Wilson, Austin, Darmawan, Kelly, Phillips, Brian, Cullum, Stav, Sharp, Christopher, Brown, Gretchen, Shieh, Lisa, Schmiesing, Clifford
• Format: Article
• Language: English
• Subjects: Nursing; Research and Applications
• ISSN: 2574-2531; 2574-2531
• DOI: 10.1093/jamiaopen/ooae057

Objective This report describes a root cause analysis of incorrect provider assignments and a standardized workflow developed to improve the clarity and accuracy of provider assignments. Materials and Methods A multidisciplinary working group involving housestaff was assembled. Key drivers were identified using value stream mapping and fishbone analysis. A report was developed to allow for the analysis of correct provider assignments. A standardized workflow was created and piloted with a single service line. Pre- and post-pilot surveys were administered to nursing staff and participating housestaff on the unit. Results Four key drivers were identified. A standardized workflow was created with an exclusive treatment team role in Epic held by a single provider at any given time, with a corresponding patient list column displaying provider information for each patient. Pre- and post-survey responses report decreased confusion, decreased provider identification errors, and increased user satisfaction among RNs and residents with sustained uptake over time. Conclusion This work demonstrates structured root cause analysis, notably engaging housestaff, to develop a standardized workflow for an understudied and growing problem. The development of tools and strategies to address the widespread burdens resulting from clinical communication failures is needed. Lay Summary Care of a hospitalized patient involves coordinating care between many members of an interdisciplinary team. Secure text messaging applications are emerging as a way to facilitate communication between different team members. These applications are joining complex ecosystems of existing communication workflows. With multiple communication modalities, increasing shift based work, and multiple providers on a team, it is increasingly confusing to know who to reach out to for concerns about patient care or requests for orders for patients. Providers want workflows that minimize disruptions and other members of the care team want to minimize the energy spent trying to find the right person to contact. We describe the state of this problem at our institution and report a deep root cause analysis conducted with a multidisciplinary team of resident physicians and nursing innovation leaders to develop a streamlined workflow to make it obvious who the responsible provider is for any given patient. We demonstrate perceived improvements in ease and fidelity of contacting the correct provider and improvement in