The mere act of sitting down helped Cohen Children’s Medical Center increase patient experience scores and improve clinical outcomes directly related to nursing care.
During rounds, bedside nurses were encouraged to sit down and spend a few minutes talking about the patient’s care.
“It seems like such a simple thing to do, but it’s really impactful. It’s impactful for our patients and families, and it’s nice for our staff to have that permission to sit down and talk to their families,” said Jennifer Simonetti, DNP, NPD-BC, CPN, the hospital’s director of Magnet, patient experience, and cultural leader.
Intended to improve communication with patients and families, the evidence-based practice has largely focused on physician rounding. Cohen Children’s expanded the practice to the nursing staff.
Sitting down promotes empathy and makes patients feel heard, Simonetti said. It also breaks down an unintended hierarchy that occurs when a caregiver stands over a patient.
“Changing the position from standing to sitting supports eye contact and helps patients and families feel they’re on the same level. It lets patients know ‘I’m here with you in an authentic way, I’m listening to you,’” Simonetti said.
Building buy-in
The initiative required a mindset shift as nurses are accustomed to multitasking and constant motion, said Sharon Goodman, DNP, NPD-BC, CPNP, the hospital’s director of clinical professional development, nursing quality, and pediatric service line. The staff wore buttons with a “Commit to Sit” logo to encourage questions from staff and patients’ family members and guardians. Approved folding chairs were stored on the unit to facilitate the effort.
Nurses participated in role playing and received an outline to guide the conversations, including ways to politely remove themselves from lengthy chats.
The encounter starts with the nurse asking permission to sit down and talk about the patient’s care. The nurse first addresses the patient’s overall experience in the hospital and then flows into specific safety concerns, such as the risk of falls and infections.
A nurse might say to a family member, “I’m worried because he is unsteady on his feet following his surgical procedure. Please make sure you’re calling me to help him get out of bed.”
“The goal is to partner with the family member or caregiver to keep the patient safe,” Goodman said.
Most encounters take three to four minutes, Goodman said, but nurses can spend up to 10 minutes.
Results
Commit to Sit was piloted on a 28-bed medical-surgical unit before being rolled out to all inpatient units a month later. It was conducted in conjunction with another quality improvement project to share peer-to-peer quality data.
A year after implementation, the combined initiatives resulted in:
- 11.4% increase in the “likelihood to recommend” domain on the HCAHAPS survey.
- 8.5% increase in nurse communication domain on the HCAHCAPS survey.
- 43% reduction in falls.
- 33% reduction in hospital-acquired pressure injuries (HAPIs).
- 48% reduction in central line associated bloodstream infections (CLABSIs).
- 100% reduction in Methicillin-resistant Staphylococcus aureus MRSA.
“We already have good numbers in these areas, but this allows us to get more granular and figure out other ways to move the dial even further,” Goodman said.
This article is based on the “Improving Pediatric Sepsis Outcomes in the QI Collaborative” presentation at CHA’s 2024 Transforming Quality Conference.
