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Table 2 PRISm background information and implementation sheet

From: Improving outcomes of hospitalized patients: the Physician Relationships, Improvising, and Sensemaking intervention protocol

Background

Studies of inpatient and outpatient teams suggest that relationships among providers have an important effect on patient outcomes.

Relationships among providers influence the way they communicate. This in turn influences the way they make sense of what is happening with their patients (sensemaking) and react in uncertain clinical situations (improvising).

P hysician team R elationships, I mprovising, and S ensem aking have been associated with outcomes for hospitalized patients, including length of stay and complication rates.

PRISm is a structured communication tool based on observations of effective inpatient teams. Its purpose is to improve patient outcomes by changing the ways that physicians communicate and improving their ability to make sense and improvise.

Intervention

The PRISm communication tool has three components:

1. Briefings before rounds—to determine how to round most efficiently

2. Structured patient discussions—using the “Situation, Task, Intent, Concern, Calibrate (STICC) ” framework

3. Debriefings after rounds—to organize care around what needs to be done, who will do it, and ensure high priority tasks are completed

PRISm is not a replacement for rounds. Instead, it should be integrated with rounds to help you round more effectively, improve patient discussions, and get all the work done.

Implementing PRISm

Before daily rounds, ask one or more of the following questions:

• Who is our sickest patient today?

• Did anyone have a change overnight?

• Who do we need to see first?

• Do we have any early admits/discharges?

• Do we have everything we need for rounds?

This quick, 5-min discussion will help to guide more efficient rounds.

While discussing individual patients, think about:

Situation: What are we dealing with?

Task: What do we need to do?

Intent: Why are we doing it?

Concern: What are we watching for?

Calibrate: What don’t we know? What do we do if…?

STICC can be used during each patient discussion, or only for specific patients.

Ask these questions when you think they would improve patient discussions.

End daily rounds by asking:

• What are our biggest priorities?

• Who do we need to talk to?

• Who is going to do what?

• How can we help each other get things done? What can I do?

This 5-min recap ensures all tasks are done most efficiently.