Implementing a team-based daily goals sheet in a non-icu setting

At 4:00 A.M. a young man was admitted to the emergency department (ED) at the Johns Hopkins Hospital with an infected hand. He was administered an antibiotic, and the ED physician recommended admission for surgical wound debridement and administration of TV antibiotics. Food and drink were withheld, and the patient was admitted to Weinberg 4C (W4C), a medical-surgical ward, and posted as an add-on surgical case for the day. In the latter part of the afternoon, the patient was hungry and anxious to know when his surgery was scheduled. The patient's nurse contacted the surgical resident who told her that the operating room (OR) schedule was booked solid and to let him eat and then reinstitute NPO [nothing by mouth] status after midnight or surgery the next day. The patient finally ate dinner at around 7:00 P.M. He was still on NPO status on day 2, but still no word of surgery had been received by 6:00 P.M on that day. The nurse again called to find out what time the patient was scheduled for debridement. The response she received was, "Surgery? He's not having surgery! That patient is going home tomorrow." In this case, the surgical team decided that the antibiotics were sufficiently treating the infection and surgical debridement was no longer necessary. However, this change to the patient's care plan was not communicated to the nurse on W4C or the patient. Poor communication between the surgical team, unit nurse, and patient led to increased patient anxiety and discomfort, ineffective coordination of discharge planning, and frustration for the nurse caregiver. Unfortunately, such communication failures are the norm rather than the exception in health care.