Standardizing Workflow to Improve Communication and Patient Outcomes in Surgical Intensive Care Unit

Introduction: In the Surgical Intensive Care Unit (SICU), inconsistencies in charge nurse communication and workflow contributed to gaps in shift handoff, incomplete audits, and missed opportunities for early intervention in patient care. Our aim was to increase structured charge nurse shift reporting and audit compliance from an inconsistent baseline (estimated < 50%) to >90% by June 2025, as measured by completed Charge Nurse Workflow Audit Sheets and documented SBAR shift emails.


Methods: The target population included charge nurses and SICU patients. Interventions included development and implementation of a Charge Nurse Workflow Audit Sheet, standardized SBAR handoff tool, and a structured email shift report to improve continuity and clarity in daily operations. Measures were tracked using chart reviews, audit tools, and electronic documentation. AI Disclosure: Artificial intelligence was utilized solely for grammatical refinement and formatting. No AI tools were used in generating the original research content or data interpretation.


Results: Post-implementation data demonstrated sustained improvements in workflow adherence and quality outcomes. Charge nurse audit compliance increased from inconsistent use to over 90% by June 2025, with shift SBAR emails adopted as routine practice. During the post-intervention period, the SICU maintained a CLABSI rate of zero (since May 2024), a CAUTI rate of zero (since October 2023), CHG compliance at 98% (goal >87%), and hand hygiene compliance at 100% (sustained since December 2012). Hospital-acquired pressure injuries (HAPIs) decreased through early identification and structured skin assessments using WoundVision and a 2-RN skin handoff. Additionally, the unit consistently met its TOTI (Transfer Out Time Indicator) goal of < 45 minutes.


Conclusions: This QI project demonstrates that standardizing charge nurse workflow and reporting improves communication, audit reliability, and clinical outcomes. The interventions provided clarity to the charge nurse role, improved consistency in leadership engagement, and supported proactive identification of at-risk patients.