A bedside communication tool did not improve the alignment of a multidisciplinary team's goals for intensive care unit patients

Purpose: Establishing well-understood daily patient care goals should improve healthcare team (HCT) communication, reduce errors, and improve patient outcomes. The purpose of this study was to test the hypothesis that implementation of a daily goals "Door Communication Card" (DCC) would improve goal alignment between members of the HCT. Methods: As part of a process improvement project, HCT members listed their top care goals for a patient on a given day. After initial data collection, DCCs were placed on patients' doors. Anyone was allowed to write on the card, but the "official" daily goals were recorded during multidisciplinary rounds. One month after introduction of the DCC, HCT members were re-queried about their patients' care goals. Three reviewers independently compared goals and assessed their alignment before and after implementation of the DCC. We collected goals over a 4-month period and selected 5 random days before and after intervention for assessment. Results: The goal alignment among HCT members was low before and did not improve after intervention (Attending-to-Nurse 55% vs 38%, P = .02; Attending-to-Resident 60% vs 54%, P = .43; Attending-to-Primary 35% vs 28%, P = .45; Nurse-to-Attending 52% vs 36%, P = .03; Nurse-to-Resident 55% vs 38%, P = .04; Nurse-to-Primary 37% vs 27%, P = .36; Resident-to-Attending 59% vs 54%, P = .4; Resident-to-Nurse 56% vs 40%, P = .05; Resident-to-Primary 36% vs 24%, P = .16; Primary-to-Attending 34% vs 42%, P = .44; Primary-to-Nurse 42% vs 35%, P = .6; Primary-to-Resident 32% vs 34%, P = .8). Conclusions: Alignment of daily patient care goals among HCT members is low overall and did not improve after implementing a DCC available to all team members. Further study to elucidate the mechanism by which daily goals forms improve patient care is required.