Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Once the image has been threatened, it is necessary for the crisis communicator to identify the most important audience or to prioritize the important audiences in a crisis situation. On page 248 of the book, you can find a chart which labels all of strategies and their key characteristics. Merck’s use of bolstering and defeasibility, wit the strategic introduction of partial blame shifting in the subsequent 2 phases, further reinforced the message and image it aimed to convey, and the message that any imputation of liability should be referred to the regulatory authority, the FDA. A friend forgot your birthday last year, so you 'forget' to send her a birthday card this year. This quiz and worksheet will help you evaluate your knowledge of various communication styles. Using SBAR to Communicate Falls Risk and Management in Inter-professional Rehabilitation Teams Healthcare Quarterly - Vol.
This study implemented and evaluated the adapted Situation-Background-Assessment-Recommendation (SBAR) tool for use on two inter-professional rehabilitation teams for the specific priority issue of falls prevention and management. The physical, psychological, social and economic consequences of falls and falls-related injuries have been well documented in the literature.
The Toronto Rehabilitation Institute (Toronto Rehab), a large academic rehabilitation and complex continuing care hospital, has embarked upon a novel patient safety strategy to improve team communication. This project had two phases: in phase one we implemented the adapted SBAR tool and in phase two we evaluated its processes and outcomes. Our previous work supported using local champions to reinforce the use of SBAR during the implementation phase and beyond.
The three main outcome measures of this study examined staff perceptions of patient safety culture, team effectiveness and falls incidence, including fall severity and near-miss reporting. Staff perceptions of patient safety culture were measured using the Hospital Survey on Patient Safety Culture (HSOPSC; Westat et al. Over the study period, the geriatric and musculoskeletal rehabilitation teams showed clinically meaningful change (using the 5% rule of thumb) in all 12 safety dimensions of the HSOPSC. At baseline, the aggregated results for the study teams scored clinically lower than results for the rest of the hospital in nine of the 12 safety dimensions, and statistically lower in six dimensions (Table 2).
The Team Orientation Scale was administered to the study teams at baseline and following the implementation of SBAR.
Falls incidence and severity, as well as near-miss reporting, were examined through our online reporting system.
The aim of the process evaluation was to further explore the uptake (or not) of SBAR on the two inter-professional rehabilitation teams and to provide additional contextual understanding of our results.
Results from this study suggest that SBAR was widely and effectively used by inter-professional rehabilitation teams as part of a broader program of safety activities.
Consider the value of context-dependent and relevant case examples to reinforce the value of SBAR during education sessions. Consider implementing SBAR in clinical environments with teams that may be underperforming. We used falls incidence and near-miss reporting as well as severity of falls as proxy measures for safety. We cannot attribute changes in safety reporting and perceptions of patient safety solely to this study; instead, these changes should be considered within the context of a range of patient safety initiatives at Toronto Rehab. We used the 5% rule of thumb to suggest clinically significant change in the HSOPSC; however, this guideline was meant to be used with large sample sizes. The purpose of this study was to implement and evaluate the adapted SBAR tool for use on two inter-professional rehabilitation teams for the specific priority issue of falls prevention and management. Angie Andreoli, BSc(PT), MSc, is the acting advanced practice leader of patient safety at the Toronto Rehabilitation Institute (Toronto Rehab), in Toronto, Ontario.
Carol Fancott, BSc(PT), MSc(PT), PhD(c), is the advanced practice leader of patient safety at Toronto Rehab.
Karima Velji, RN, PhD, is vice-president of clinical and residential programs and chief nursing officer at Baycrest Hospital in Toronto, Ontario.
Sherra Solway, BSc(PT), MHSc, CHE, is the director of patient safety, best practice, and patient care projects at Toronto Rehab. Elaine Aimone, BSc(PT), MSc, is the director of quality and risk services and accreditation manager at Toronto Rehab.
Gaétan Tardif, MD, FRCPD, FCCHSE, is vice-president of quality patient care and chief medical officer at Toronto Rehab, and a professor of medicine at the University of Toronto. This project was jointly funded by the Canadian Patient Safety Institute and the Toronto Rehabilitation Institute.
American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Now, Merck had claimed it withdrew the drug based on results of a 3 year clinical study that it had received days earlier.
For these assessments, you will need to be able to identify examples of the various communication styles and an example of a communication technique that is used the assertive style. We would very much appreciate if you could complete our site survey so that we may gain from your experiences and ensure that our future plans and enhancements target your specific needs. SBAR has been widely studied in the literature, but rarely in the context of rehabilitation and beyond nurse-physician communication.


Each year in Canada, approximately one third of healthy, community-dwelling older adults experience a fall (Registered Nurses Association of Ontario [RNAO] 2007).
Both units are similar in size, admit similar patient populations (older adults with multiple co-morbidities) and have similar lengths of stay (ranging from 35 to 40 days).
A series of three education workshops (a total of four hours) introduced staff to key elements of patient safety including communication breakdown in healthcare, a systems approach to safety culture, openness to reporting incidents and near misses and the use SBAR to facilitate communication.
We also used a series of reminder tools including pocket cards, posters, telephone prompts and educational binders that were located strategically throughout the units. Outcomes were measured using a pre-post test design, and data from the study teams are presented in aggregate form.
Many of these improvements were greater than 10% and ranged as high as 28% in the Handoffs and Transitions dimension, which is an area of emphasis for the organization. It compares the changes within the study units and the control group pre- and post-intervention. This scale measures team effectiveness and incorporates issues of team communication, team perspectives and valuing others, and is part of a larger questionnaire based on the cognitive-motivational survey by Millward and Purvis (1998). Severity ratings were categorized in four levels (no harm, minor, moderate and major) and tracked over an 18-month period, including the six months leading up to and following the study period.
To do this, we conducted brief one-on-one interviews with all participants mid-way through the study. First, staff used SBAR to communicate falls prevention and management; but they also used the tool in a variety of other clinical and non-clinical contexts, for example, as a debriefing tool and to discuss changes in team processes. In particular, we have seen compelling changes in staff perceptions of safety culture, as well as effective team processes and communication. SBAR champions emerged naturally from the study teams and were an effective means to reinforce, encourage and model the use of SBAR. We developed role-playing scenarios from clinical situations that were meaningful to the study teams, as an effective means to practise the SBAR process. From our previous work, we developed an implementation tool kit for enhanced uptake of SBAR in other healthcare settings. While near-miss and total major falls showed a decreasing trend, total falls on the study units increased. For example, new initiatives regarding leader engagement, upgrades to our online reporting system and a corporate-wide falls best practice initiative have all increased awareness of safety and incident reporting across the organization.
We chose to aggregate the study results for a number of reasons, including statistical power.
Issues of patient safety and communication have been studied in the literature, but usually from the perspective of acute care and involving nurse-physician communication. Ross Baker, PhD, is a professor in the Department of Health Policy, Management and Evaluation at the University of Toronto. These strategies can be used alone or together throughout the restoration process, but should be kept mildly consistent. However, allegations of cardiovascular risks surfaced as early as 2000, a year after it was introduced. You wait until she is alone, and then let her know that you were sad to hear her say such a thing.
In phase one, the adapted SBAR tool was implemented on two teams with a high falls incidence over a six-month period. Falls in hospitals are almost three times this rate and account for up to 84% of all in-patient incidents (Halfon et al. Role-playing using real-life case examples related to falls risk assessment, prevention and management was used to demonstrate how SBAR may be implemented in clinical situations. A member of the research team or SBAR champion also attended weekly team rounds as a way to further reinforce the use of SBAR, and to understand the situations in which SBAR was being used (or not), with whom and in what context. The process evaluation involved a multimodal approach that aimed to better understand the context and uptake of SBAR on the two inter-professional teams. The 43-item survey can be used to track changes in patient safety culture over time, as well as to evaluate the impact of patient safety interventions at both the organization and unit levels. While the organization showed some improvements in clinical (one dimension) and statistical scores (four dimensions), the study teams demonstrated clinically significant change in 10 dimensions and statistically significant change in nine. Both near-miss reporting and the number of major falls demonstrated an overall decreasing trend across both the organization and the study units. We also held focus groups (n = 18) on each of the study units at the end of the implementation period. We also included clinical and support staff in both phases of the study, which made the SBAR process relevant to the entire rehabilitation unit and additionally recognized the key role that support staff play in patient safety within the organization.
Whatever the context, SBAR was not used randomly − staff consistently used the tool for what they perceived to be sensitive or hierarchical issues. Implementing change initiatives, even pilot studies, on high-performing teams may be a lost opportunity.
It would also be interesting to look at the study units individually with the specific purpose of sharing key learnings across our organization. This study contributes to the literature in patient safety by examining the influence that strong inter-professional team collaboration and communication can have on falls prevention and management in rehabilitation. In the two years leading up to the study, falls on these units constituted 43% of all reported falls in our organization (excluding long-term care).


These scenarios provided participants with powerful feedback in learning how to apply the tool.
The survey consists of 12 patient safety domains and has been found to be valid and reliable.
Pre-and post-implementation, the study teams showed significant change in four of the 10 items, including items that emphasized effective and agreed-upon methods of communication, and a belief that participants' contributions were valued (Table 4). Each focus group was conducted by two experienced moderators and was audiotaped and transcribed verbatim.
Finally, we found that reminder tools, such as telephone prompts and pocket cards were useful and widely utilized. First, the data may be trended across a time frame that is too short to determine accurate results and may therefore be inconclusive. These results suggest that the adapted SBAR process is an effective way to communicate urgent and non-urgent safety issues and has the potential to be widely used among inter-professional teams.
This study suggests that the adapted SBAR tool was widely and effectively used by inter-professional rehabilitation teams as part of a broader program of safety activities. There is compelling evidence, however, that falls can be prevented through timely risk detection and appropriate management. The SBAR tool is a situational briefing model that provides appropriate assertion, critical language and education to a safety issue (Leonard et al. All Toronto Rehab staff (n = 1,700) were sent the survey prior to the implementation of SBAR and approximately 12 months later. These data do not account for repeat fallers; nor do they consider whether falls increased on these units or if staff were simply reporting more incidents. These groups provided us with an in depth understanding of the enablers of and barriers to using structured communication on inter-professional teams.
The DVD uses falls prevention and management as a platform to highlight inter-professional team communication in two different scenarios: during team rounds and between two clinicians on the nursing unit.
Second, the nature of rehabilitation is to push patients to the limits of their abilities in order to maximize function. Near-miss and severity of falls incidence trended downward but were inconclusive, likely due to a short time frame as well as the nature of rehabilitation, which pushes patients to the limit of their abilities. Numerous guidelines have emerged over the past decade outlining best practice for falls risk prevention and management both within healthcare settings and in the community (American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons Panel on Falls Prevention 2001; RNAO 2007). Response rates pre- and post-intervention were 31% (n = 520) and 33% (n = 569), respectively. Figure 2 shows the total number of major falls, or falls causing serious injury, on the two study team units rehabilitation units compared to the entire organization. For example, at the beginning of the study participants regularly said to us, "We are good communicators. In this way, the risk of falls and other events are an inherent part of the rehabilitation process.
While SBAR has been adapted for use within our setting, it is one of a number of structured team communication tools. Farnborough, United Kingdom: Defense Evaluation Research Agency, Centre for Human Sciences.
While SBAR was used in the context of falls prevention and management, it was also utilized it in a variety of other clinical and non-clinical situations such as transitions in care, as a debriefing tool and for conflict resolution. Inherent within these guidelines is the need for strong inter-professional team collaboration and communication. While many organizations have implemented the SBAR tool, there is little evidence regarding its effectiveness beyond the acute care environment and nurse-physician communication. The study teams had a response rate of 87% (n = 74) pre-intervention and 69% (n = 59) post-intervention.
The accompanying facilitator's guide emphasizes key teaching moments for educators to consider when SBAR education sessions.
Our hope is that these learnings are transferable to other healthcare settings, settings that also recognize the importance (and challenges) of communicating in inter-professional teams. Communication breakdown has long been cited as the leading cause of inadvertent patient harm, including falls (Joint Commission on Accreditation of Health Care Organizations 2004). The pilot study offered preliminary insights into how SBAR may be used and evaluated within an inter-professional rehabilitation team. Suggestions are provided to other organizations considering adopting the SBAR tool within their clinical settings, including the use of an implementation tool kit and video simulation for enhanced uptake. All too frequently, however, communication is context or personality dependent and influenced by a myriad of factors including gender, culture, profession and structured hierarchies within healthcare (Leonard et al. We also tested for statistical significance within the study units, as well as compared with the rest of the hospital, which served as our control group.
Many participants expressed that while they were able to provide the situation and background of an issue; they only sometimes offered their assessment and rarely made a recommendation.



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