GME creates video vignettes to help frame clinical conversations
Resident shows up on the unit and talks with the nurse:
Resident: “Hi Valeria. So what’s happening with Mr. Jones?”
Nurse: “Well, I think he has a bed sore on his hip and we need to see if it’s infected.”
Resident: “What labs are you talking about doing?”
Nurse: “I’m not sure. That’s why I called you.”
Resident: “I think I should wait until my senior gets back from lunch to figure out the orders.”
Nurse: “Oh, OK. I guess I’ll just wait.”
Conversations like these play out at hospitals across the country, but EVMS Graduate Medical Education is working to change that.
As part of the training for new residents, fellows and RNs, GME staff members are creating video vignettes that facilitate inter-professional collaboration training by using ISBAR (Identify, Situation, Background, Assessment and Recommendation) to better frame clinical conversations.
“We know when nurses and physicians collaborate effectively, this decreases the chances of making patient-care mistakes and errors,” says Agatha Parks-Savage, EdD, RN, Assistant Dean of Graduate Medical Education and Associate Professor of Family and Community Medicine at EVMS. “Decreasing mistakes and improving patient outcomes are two of the biggest goals for all medical professionals.”
Each vignette begins with how not to handle a situation, like the one above. It’s followed by another video with a recommended course of action using ISBAR.
Opening Scene:
Resident shows up at the nursing station where the nurse is sitting.
Resident: “Hi Valeria. I know a little about Mr. Jones, but tell me what’s happening.”
Nurse:
(IDENTIFY)
- Hello Dr. Edwards. Yes, Mr. Jones is an 86-year-old male.
(SITUATION)
- I am concerned that he’s showing signs of a wound infection and skin breakdown on his right hip.
(BACKGROUND)
- He was admitted for congestive heart failure and has been in the hospital for about a week.
- Actually, he is doing well with his CHF, it’s this bed sore that might be problem now.
- He is not very motivated to walk and prefers lying in bed, even when we tell him to sit up in the chair.
(ASSESSMENT)
- I checked him this morning and he has a nickel-sized open bed sore on his right hip with increased discharge, redness, it’s warm to touch, and he reports a pain level of 4-5.
- Looks like it might be a stage 2 pressure sore. His vital signs are temp, 99.6 (elevated from last night), heart rate is 80, respirations are 12, and blood pressure is 130/84.
(RECOMMENDATIONS/RESPONSE)
- Can we consider ordering labs to check is CBC and then get an order for the wound nurse to take a look at him?
- What do you think?
Resident:
- It does seem like something is going on.
- I’m going to take a look at him first.
- If you have time can you come with me?
The videos will also be shared during the Accreditation Council for Graduate Medical Education conference in March to help faculty members and program directors manage crucial conversations with residents who are struggling in their training program.