Cross-Monitoring for Smooth Recovery

Case Study: Cross-Monitoring for Smooth Recovery

Mrs. Ashburn is a patient on the cardiac care unit of the hospital recovering from triple bypass heart surgery. Her past medical history includes rheumatoid arthritis affecting both knees and ankles that requires the use of a wheeled walker for ambulation. Her cardiologist has consulted physical therapy to begin her cardiac rehabilitation walking program. At day 2 after surgery she is still wearing a heart monitor, which sends a signal to the electrocardiography (ECG) technician station. Nurses oversee her pain medication, her vital signs, and care of her incisions. The respiratory therapist instructed Mrs. Ashburn on use of the spirometer to encourage deep breathing and reduce the risk of developing pneumonia. Each healthcare team member has an important role in promoting successful recovery from surgery. The physical therapist checks in with the nurse caring for Mrs. Ashburn to see how she has been doing for the past 24 hours. The physical therapist also checks in with the ECG-monitor technicians to discuss the current readings from Mrs. Ashburn’s heart monitor and to alert them that she will be taking the patient for a walk in the hallway. The physical therapist checks her heart rate, blood pressure, and oxygen saturation before walking with her in the hallway. Midway through the walk in the hallway with the physical therapist, the ECG technician notes an abnormal heart rhythm and calls the nurse to communicate this information. The nurse brings a wheelchair to the hallway and suggests they take a rest break. The physical therapist and nurse closely monitor her heart rate, blood pressure, and oxygen saturation. Mrs. Ashburn says that she feels a little tired but otherwise alright. After a few minutes of rest, the ECG technician notifies them that her heart rhythm has returned to normal. The nurse and PT walk Mrs. Ashburn back to her room.

Discussion Questions

1. Why was it important to have an interprofessional team cross-monitoring and communicating about the patient’s status during activity? What could have happened if patient care decisions were made “in a silo”?
2. Imagine that the nurse had handled the situation differently, placing blame for the episode of abnormal heart rhythm rather than addressing it with the team. What would have been the impact on the patient? What would have been the impact on the physical therapist?
3. Identify at least three examples in this case study in which team members effectively engaged others in the plan of care. Can you suggest additional strategies that they could use?

1. Having an interprofessional team cross-monitoring and communicating about the patient’s status during activity is crucial for several reasons. First, in a complex medical scenario like post-cardiac surgery, different healthcare professionals bring unique expertise and perspectives to the patient’s care. The physical therapist, nurse, ECG technician, and respiratory therapist all play distinct roles that, when coordinated, ensure comprehensive care and early detection of issues. If decisions were made in isolation or “in a silo,” crucial information might be missed or misinterpreted, potentially leading to delayed intervention or adverse outcomes for the patient. In this case, the abnormal heart rhythm was detected promptly because of the cross-communication, allowing for immediate action and preventing further complications.
2. If the nurse had handled the situation by blaming the physical therapist or any other team member instead of addressing the issue collaboratively, it could have had detrimental effects. Blame-shifting would have created a tense and unproductive environment, potentially affecting the quality of care for the patient. The impact on the patient could include increased stress and anxiety, hindering the recovery process. The physical therapist might have felt demoralized or hesitant to collaborate further, impacting the effectiveness of teamwork and potentially compromising future patient care.
3. Examples of effective engagement among team members in this case study include: a. The physical therapist proactively communicating with both the nurse and ECG technicians before taking the patient for a walk, ensuring everyone was aware and prepared. b. The ECG technician promptly notifying the nurse about the abnormal heart rhythm, initiating a quick response and coordinated action. c. The nurse and physical therapist closely monitoring the patient’s vital signs and responding immediately with rest and observation.

Additional strategies for effective engagement and collaboration could include:

• Regular interdisciplinary team meetings or huddles where members discuss patient progress, potential concerns, and upcoming interventions.
• Implementing a standardized communication system, such as SBAR (Situation, Background, Assessment, Recommendation), for sharing critical patient information among team members.
• Encouraging a culture of open communication and mutual respect among team members to facilitate the sharing of observations, concerns, and suggestions without fear of reprisal or blame.

Enhancing communication channels and fostering a collaborative environment can further strengthen teamwork, improving patient outcomes and overall care quality.