Rounds Preview: Excelling in Cardiac Care

"Protocol is for everyone. We have a separate protocol for the nurses and 17 staff nurse practitioners. Many of those protocols are part of the same protocol book because that's the part that always stays—what medicine to give once a patient gets into trouble and so forth." Nurses also have protocols for everything from handoffs to how they should sign out, he says. As rigid as the protocol is for the team, it is nonetheless a living document that is updated regularly when evidence is reviewed, Sharma says. And as much as a set of protocols works well for Mount Sinai, that same book might not be a fit somewhere else.

"I'm not saying that people should duplicate what we have, but clearly there should be a set protocol. In this field, there is more than one right way to do things. At the same time, by and large, the concept has to be that when the variation occurs, that's where the trouble occurs." Other programs may modify protocols based on their needs, as long as the principles are mandatory. It's also important that all team members feel a sense of ownership of the protocol, and that their suggestions are heard, he says.

"Many times one of the voluntary physicians makes some good suggestions, so we will change our protocol based on incorporating their opinion," Sharma says.

That sense of full teamwork extends to any communication following complications, Sharma says. "If an issue occurs, we discuss it openly. That is a key, that open communication. If you have a closed-door discussion with one or two people, then other people on the team don't know. On any major complications, we speak the next morning. Then monthly we have a one-hour discussion to review."

This article appears in the June 2012 issue of HealthLeaders magazine.

Reprint HLR0612-11