Relationships between physicians, nurses, patient care assistants and other healthcare personnel (HCP) are thought to influence coordination of care and consequently, rates of healthcare-associated infections. However, there are no validated tools to quantify these relationships. Relational coordination (RC) survey is a new interventional tool designed to measure seven aspects of relationships between groups – timeliness, accuracy, frequency and problem-solving nature of communication; and shared respect, goals and knowledge between groups. The rating is a 5-point scale, with 5 being the best. The responses are aggregated to determine an ‘RC score’. Averaged scores less than 4 are used to give feedback to groups and explore opportunities to improve relationships.
As part of a hospital-wide initiative to ‘Reduce Infections Together in Everyone’, we measured RC scores between HCP types in selected hospital units with high infection rates and low infection rates. The intent was observational and exploratory.
The ICUs and Wards at a public academic hospital (which has 5 ICUs and over 20 wards) were ranked separately by their central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) rates per routine infection control surveillance in the prior year. All ICUs, and wards with more than 100 catheter-days per month and an infection rate in the highest or the lowest quartile were included. The RC survey was administered electronically. The RC scores were determined and analyzed by high vs. low infection rate.
Results: Five units with high CLABSI rate and four units with low CLABSI rate, and three units with high CAUTI rate and five units with low CAUTI rate were eligible for the RC survey. The overall response rate was 48% (123/256) for urinary catheters, and 33% (127/384) for central lines. The average RC score in the high CLABSI group was 3.11 whereas the average RC score in low CLABSI group was 3.09. The average RC score for high CAUTI group was 3.08 and for low CAUTI group, it was 3.27. The differences were not statistically significant.
Conclusion: Exploring differences between relational coordination among HCP in hospital areas with high and low infection rates using the RC survey tool was of low yield. RC scores may still be helpful for the qualitative information they generate.