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Improving Communication in the Surgical Intensive Care Unit. A Prospective Trial
Mallory Williams1, Rodrigo F Alban1, James P Hardy1, David A Oxman1, Edward Garcia1, Cristina M Thorsen2, Gyorgy Frendl1, Selwyn O Rogers, Jr.1
1Brigham and Women's Hospital, Boston, MA;2Harvard School of Public Health, Boston, MA

Objectives: To describe resident-fellow patient care communication patterns in the surgical intensive care unit (SICU), and correlate established communication patterns with short-term patient outcomes (STO). To institute an intervention to improve SICU communication.
Design: Prospective observational trial with intervention
Setting: Academic tertiary care referral center
Patients: Patients admitted to SICU.
Intervention: Residents oriented about value of communication in the SICU. During intervention period, fellow to resident nightly phone calls were made.
Main Outcome Measures: Number of events of hypotension, desaturation, tachypnea, or new arrythmias. The STO of each event was defined as improved, not improved, or worse. Number of cardiorespiratory events that were communicated, mis-communicated (MC), and non-communicated (NC) were collected pre and postintervention.
Results: 312 events were collected (166 preintervention and 146 postintervention). Communication of events was 65% preintervention and 69% postintervention (p=NS). Events were more likely to be MC or NC in the late shift (p< 0.0001). The late shift was responsible for 77% of all MC and NC events. The intervention decreased MC and NC events in the late shift by 10% (p=NS). MC and NC events had worse STO than communicated events (p<0.0002). Communication was a significant predictor of improved STO (p<0.0003).
Table I
Time of DayType of Communication
of Events
CommunicatedMis and Noncommunicated
Early Shift
83% (117)17% (24)
Late Shift
(9 PM -7AM)
54% (92)46% (79)

p < 0.0001
Table 2
Type of Communication
of Events
Short Term Outcomes
ImprovedNot Improved
Communicated90% (189)10% (20)
Mis and Noncommunicated75% (77)25% (26)

p < 0.0002
Conclusion: Communication breakdowns occur more frequently during the late shift. These communication breakdowns are associated with worse STO.

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