Luminary Learning Gastrointestinal Disorder- Issue 1

Learning to Work Together Through Talk: Continuing Professional Development in Medicine •  61 without trainees (O’Leary et al., 2011). They standardised where and when SIDRs took place, who participated, and how long rounds lasted. Nurses’ perceptions of collaboration and team- work subsequently improved. Importantly, key safety measures got better (O’Leary et al., 2011): patients hospitalized on units with medical trainees had significantly lower rates of preventable adverse events. In a subsequent study, preparing physicians and nurses to share leadership within SIDRs improved teamwork and communication, as measured by a Safety Attitudes Questionnaire (O’Leary et al., 2014). Stein and colleagues (2015) built on this work and reorganized the workflow of a hospital ward to create what they call an accountable care unit. In doing so, they integrated: (a) unit-based teams, (b) structured interdisciplinary bedside rounds, (c) unit-level performance reporting, and (d) unit-level nurse and physician co-leadership. Similar to the work by O’Leary and colleagues (2014), Stein and team (2015) structured rounds to include interdisciplinary input and shared leadership structures. Dissimilar was the location of rounds themselves; Stein and team conducted rounds at the bedside with a standard communication protocol that also engaged the patient. All participants prepared in advance to promote efficient and accurate information exchange. A preset choreography allowed each actor to play their role, from unit charge nurse, bedside nurse, junior physician, medical students, to allied health professionals. The protocol included daily review of a quality safety checklist. Health professionals, patients and families all reviewed the plan of care together to ensure shared understanding. Importantly, restructuring the hospital ward into an accountable care unit enhanced communication and work climate whilst reducing unadjustedmortality rates by half (from 2.3 to 1.1%). Examples of family-centred rounds exist also in paediatrics (Muething, Kotagal, Schoettker, Gonzalez del Rey, and DeWitt, 2007). These innovations worked in part because they brought together interprofessional teams in both time and space, which served to facilitate the talk of collaborative clinical practice and harmonize patient care. Improving Patient Handoffs Given the variable size, weight, and developmental stage of sick and injured children (Luten et al., 2002), paediatric units are at particularly high-risk of communication errors (Kohn et al., 2000). Some attempts to standardize handoffs, focusing solely on information transfer, have not yielded the expected benefits (Cohen et al., 2012) but more comprehensively designed hand- offs have been successful. Starmer and colleagues (2012) developed a mnemonic to standardize verbal handoffs called I-PASS, whose elements were: zz I: Illness severity in terms of patient stability or potential for deterioration zz P: Patient summary of key events, ongoing assessment/plan zz A: Action list of key to-do items zz S: Situation awareness and contingency planning zz S: Synthesis by receiver to summarize key elements, ask questions, restate key to-do items Beyond clear and accurate information transfer, this model encourages providers to process what they have heard, repeat back key elements, and speak up with questions or concerns. This process helps them understand what to anticipate and what tasks they must complete. In other