Improving nurse-physician communication and satisfaction in the intensive care unit with a daily goals worksheet

OBJETIVE To evaluate the effect of a standardized worksheet on physicians' and nurses' perceptions ql'their understanding q1'goals qf care and on patients' length ofstay in an intensive care unit. METHODS A worlisheet was completed daily during multidisciplinarv rounds and was posted at each bedside in the medical intensive care unit at Beth Israel Medical Center in New York. Information recorded included tests or procedures, medications, sedation, analgesia, catheters, consultations, nutrition, mobilization, family discussions, consents, and disposition. Attending physicians, residents, and nurses completed a questionnaire before implementation of the worksheet and 3 times afterwards. Responses were scored on a 5-point scale (1 = understand nothing, 5 = completely understand). Continuous variables were analyzed by using a t test; categorical variables, by using a chi(2) test. RESULTS Before the worksheet was implemented, scores for understanding goals were 3.9 for nurses and 4.6 for physicians. Scores increased to 4.8 for nurses (P = .001) and 4.9 for physicians (P = .03) 6 weeks later, an improvement that remained at 9 months. Both groups showed significant improvement in commuunication scores that lasted for 9 months. Most responders wanted to continue using the worksheet. During the study, the mean stay in the unit was 4.3 days, down from 6.4 days for the analogous 9-month period in the preceding year (P =. 02). CONCLUSION Nurses' and physicians' perceptions of their understanding of the goals of care and communication between them were improved and stays in the unit were shortened when the worksheet was used.