Dr. Susan Shaw, a critical care doctor in Saskatoon, decided to conduct a clinical trial. For this one, though, she used the Lean PDSA cycle: Plan, Do, Study, Act. It required no IRB approval and could be replicated by any doctor out there.
What was this? She was inspired by Liz Crocker’s talk at the provincial Health Care Quality Summit a few months ago, and also by a story told by Bonnie Brossart. She wondered how much time it would add to her work day, and what would be the results, if she asked each patient a question.
Her summary of the trial was recently posted:
Plan: For one week, at the end of each bedside round, ask the patient and/or the family “Is there anything else I can do for you today?”
Do: Do and describe what happened. I chose the following measures: how much time asking and answering the question took, how many yes’s how many no’s and what additional questions and requests were asked.
Study: Analyze the results and determine what you learned.
Act: Adapt, adopt, or abandon the change based on what you learned. Then complete the cycle testing out another small change.
Here is a description of the protocol employed:
I didn’t use any fancy data collection tools. Just a pen and a piece of paper that I carried in my back pocket, along with some additional attention paid to the clock on the wall. And I wrote down the answers to my question, which I asked 87 times over the course of one week.
And, finally, the results:
What did I discover? Asking “Is there anything else I can do for you today?” added an average of 4.5 seconds to the length of the time I spent rounding with each patient
Asking this important question did not slow me or my team down. I did not get asked any difficult or awkward questions. I felt like I made a stronger connection with the patients and families in the ICU. And I liked that this simple question provided a sense of closure to the round while signaling to the patient and family that we truly were interested in helping and supporting them.
I also smiled a big smile when I overheard two of the four residents working with me that week asking the same question of nurses, patients, and families when they were working at the patient’s bedside.