Some of the CSICU team at Royal Columbian Hospital: (l to r) Christopher MacGregor, Michelle Nicholas, Jennafer Winder, Jennifer Gregory and Alana Larkin.

Some of the CSICU team at Royal Columbian Hospital: From left to right, Christopher MacGregor, Michelle Nicholas, Jennafer Winder, Jennifer Gregory and Alana Larkin.

Healthcare teams that communicate effectively and follow a systematic approach to communication have better patient outcomes, higher staff morale and a positive safety culture. And regardless of role or area of expertise, communication skills and practices can always be improved upon, which is why the Cardiac Surgery Intensive Care Unit (CSICU) at Royal Columbian Hospital (RCH), came up with strategies to improve communication when their unit wasn’t running as safely and efficiently as they wanted it to.

Their initiative began two years ago when CSICU staff voiced concerns about patient flow on the unit. With high patient turn-over on a daily basis, staff was concerned miscommunication was impacting patient safety. They didn’t know when patients were coming to CSICU from other areas of the hospital, for example, or when patients were scheduled to leave their unit, there were issues with beds not being ready when they needed to be and staff were uncertain about who to call if there was an emergency, such as a code blue.

“Staff told me there was a real disconnect on the unit,” says Deljit Bains, CSICU Manager at the time. “Just planning for the day was an issue and caused a lot of confusion. Staff said they didn’t have time to read emails and suggested a physical space on the unit where they could go and see what was happening each day. They felt some kind of communication tool would help staff on our unit and other hospital staff who worked with us as well.”

The team designed a large, laminated communication board and called it the “PQRST” – Plan, Quality, Reminder, Safety and Team. An appropriate title…first because it would capture all the information they needed, and second because PQRST is also a well-known acronym to measure heart rhythm. The team put up the board in the main CSICU hallway for staff to write down important details for each day, along with general quality and safety reminders for staff.

PQRST board

The PQRST communication board developed by the CSICU team at Royal Columbian Hospital.

In addition to their new communication board, the team also implemented regular 3-minute POD chats (at the bedside) at the beginning of each shift. The daily plan and key discussion points from the POD chats are captured on the PQRST board. Today, this two-step communication process has become an important part of patient handovers for RCH’s CSICU.

Alana Larkin, RN, and Jennifer Gregory, RN, presented their success at the Canadian Cardiovascular Congress held in Toronto last October. They say it was an excellent opportunity to present their communication strategies to a broader audience. “Communication is something every unit struggles with so I think that’s why our poster was so well received,” says Alana. Jennifer says, “Frontline nurses tend to find solutions on their own, within their own team, so it was nice to offer our communication tool to others who might benefit.” 

PQRST poster presentation

Alana Larkin, RN, and Jennifer Gregory, RN, presented at the Canadian Cardiovascular Congress in 2015.

When asked about PSLS and what she likes most about it, Deljit says the system gives staff a way to share their experiences and allows them to shape safe care for patients.

“There are always ways to make improvements and always something to learn and I believe PSLS gives us both opportunities.”

Great job RCH CSICU team!

Do you have suggestions to improve healthcare communication? Share your comments below.

The PQRST communication model was developed by the Cardiac Surgery Intensive Care Unit Professional Practice Team at Royal Columbian Hospital: Deljit Bains, Melissa Borromeo, Jennifer Gregory, Alana Larkin, Christopher MacGregor, Michelle Nicholas, Janet Savard, and Jennafer Winder.

Royal Columbian Hospital’s Cardiac Surgery Intensive Care Unit has 9 patient beds and handles 950 open heart surgeries and 145 acute medical admissions a year. It is one of the busiest catheter labs in Canada.

For more stories about communication in healthcare, please read:

For more information about RCH’s CSICU communication project, please contact:

Christopher MacGregor, Clinical Nurse Specialist

Deljit Bains, Leader, South Asian Health Institute


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