1816 - Improving Overnight Communication between Nursing Staff and On-Call Residents Utilizing ISBAR framework: A Quality Improvement Project

Objectives: This quality improvement project aimed to evaluate and enhance overnight communication between nursing staff and on-call Physical Medicine and Rehabilitation (PM&R) residents on the Acute Inpatient Rehabilitation Unit at the University of Kansas Medical Center (KUMC). Specifically, the project sought to implement the ISBAR (Identify, Situation, Background, Assessment, Recommendation) communication framework to improve clarity, efficiency, and patient safety during the 1900–0700 shift.

Design: A root cause analysis was conducted with unit leadership, nursing staff, residents, and attendings to identify barriers to effective communication. Based on these findings, a new Voalte template structured around ISBAR was created for night shift nurses to use when contacting on-call residents. Pre- and post-intervention data were collected during on-call weeks, including frequency of ISBAR use and perceived communication effectiveness. Post-intervention surveys were distributed to both nursing staff and residents to assess impact and balance measures.

Results: Following implementation, residents reported improved clarity of communication and fewer redundant requests, such as medication already available in the MAR. However, multiple barriers emerged. Nursing staff found the Voalte template time-intensive, burdensome for simple patient needs, and challenging for staff with lower technology literacy. Residents noted difficulty determining urgency within lengthy ISBAR messages. These limitations contributed to failure in achieving the target of >90% ISBAR utilization. Balance measures highlighted concerns regarding efficiency, nursing burden, and the need for clearer guidelines on when full ISBAR communication is necessary.

Conclusions: The ISBAR framework demonstrated value in improving communication clarity but presented significant challenges in workflow integration. To optimize its effectiveness, modifications are needed to reduce burden, improve efficiency, and tailor use to critical scenarios. Future directions include refining ISBAR templates, providing targeted training for staff, and ongoing evaluation to ensure sustainability. Successful adoption will require organizational support and a culture prioritizing clear, efficient communication to enhance patient safety.