Addressing Patient Experience in the Emergency Department Through a Standard Communication Framework: Connect, Ask, Respect, Ensures Understanding, Summarize (CARES)

Aim: : Consistently, patients and families identify communication as a key area for improvement. Risks of poor provider to patient communication include poor patient outcomes, increased emergency department (ED) re-visits, readmissions and poor patient experiences. Implementation of a standardized communication framework aligns with a commitment to patient and family centered care and a high reliability framework. The aim of this project was to implement a standard communication framework (CARES) for ED nurses, evaluate knowledge gains after an educational intervention, and compare pre- and post- patient experience data, synthesizing science-based innovation to improve nursing practice.

Framework:: The CARES framework, an evidence-based tool developed by an interdisciplinary steering committee at the project site, helps clinicians to communicate with patients and families in a way that puts the patient at the center of their care in an inclusive and respectful manner.

Setting:: This project took place in a quaternary urban freestanding 412-bed pediatric hospital ED in the Northeastern United States.

Stakeholder Team:: The project lead is a DNP prepared nurse leader who holds a nurse executive board certification. The project lead had project site supported by DNP and PhD prepared nurse scientists who are experts in the field of research and quality improvement. Two expert lead nurses, an expert master’s prepared ED educator and a bachelor's prepared staff nurse, were included.

Methods: : This quality improvement project used one-group pre- and post-design with a longitudinal data collection period to measure nursing knowledge and family satisfaction scores following a CARES educational intervention and rollout. Participants responded to a Likert survey and open-ended questions pre- and 12-weeks-post-intervention. Face and content validity were evaluated by MSN prepared nurse educators. Travel and agency nurses were excluded from this project. The paired data were analyzed using descriptive statistics and thematic analysis. Unit champions supported the rollout and audited framework use.

Outcomes:: Of 106 eligible nurses, 84 (79%) completed the pre-education survey. Matching of unique identifiers reduced the sample to 12 participants. While no statistically significant change was found between the pre- and post-education surveys, there was clinical significance. The majority of participants “strongly agreed” that they keep patients and families updated on their care regularly. Post-education, 65% agreed that their communication was effective even during busy shifts. Patient experience surveys demonstrated improved scores for keeping patients informed. Communication barrier themes included ED team communication, time constraints, capacity, and language barriers.

Implications:: Given the consequences of ineffective communication on patient safety and satisfaction, there is a critical need to improve communication efficacy in the ED setting. This project informed a current pilot in an outpatient clinic with providers. Data from this project will be compared to outpatient clinic data to inform future practice, including a rollout to interdisciplinary teams across the institution. Improving communication can improve patient outcomes, patient satisfaction, and staff satisfaction.