CARING PARTNERSHIP: Michelle Anderson, RN, an attending nurse on White 7, reviews the new “Patient and Family Notebook” with patient Gerald Marcoux.
A patient has been recovering on White 7 following surgery. His scheduled discharge date – marked on the whiteboard in his room and on an electronic whiteboard at the nurses’ station – is approaching. The patient’s nurse wants to make sure he and his family will be ready for discharge and answers questions while one family member jots down notes in their “Patient and Family Notebook.” As they talk, the unit’s attending nurse stops by and listens to the patient’s concern about the side effects of a pain medication he’ll be taking once at home. Using her specially programmed Voalté phone, the attending nurse sends a text message to the attending pharmacist and physician. The team plans to meet and discuss the issue with the patient and his loved ones.
This scenario offers only a glimpse into some of the cutting-edge practices and technologies being implemented on the 12 inpatient units selected as Innovation Units (see below for a list of participating units). Led by Patient Affordability Direct Care team leaders – Jeanette Ives Erickson, RN, DNP, senior vice president for Patient Care Services and chief nurse, and W. Scott McDougal, MD, chief of Urology – the Innovation Units project officially launched March 19. The kickoff is the culmination of months of in-depth planning and preparation, during which top-priority interventions were identified by interdisciplinary teams with helpful input from patients and their families.
As part of the Patient Affordability and Care Redesign initiative at the MGH and Partners HealthCare, the 12 units are now testing grounds for promising new strategies to improve clinical outcomes and enhance patient, family and staff satisfaction – while reducing costs and length of stay. The success of the interventions is being evaluated based on a series of set metrics. The interventions include:
Implement a new attending nurse role
The attending nurse is a staff nurse who collaborates with the attending physician to ensure each patient’s consistent and timely progression on a unit from admission to discharge. Working eight hours a day, five days a week, the attending nurse is a constant presence and a resource for both patients and staff.
Improve handoff communication
Use of the SBAR (situation, background, assessment and recommendations) tool is now standard practice when a change in a
patient’s care team or care plan is necessary – whether internal, such as transitioning a patient to the night-shift nurse, or external, when a patient is transferring to another facility or returning home.
Collect additional preadmission data
A revised admitting face sheet offers more detailed information – including an anticipated discharge date and where a patient will go after discharge – to better inform the care team.
Encourage patient-provider dialogue
The newly developed “Patient and Family Notebook” educates patients and their loved ones about the different members of their care team while encouraging them to take a more active role in their health by asking questions and taking notes.
Begin interdisciplinary team rounds
Implementing interdisciplinary rounds provides a formal opportunity for all members of the care team to meet daily in order to ensure seamless, integrated care delivery. To make these rounds as effective as possible, each discipline – including Nursing, Physical Therapy, Occupational Therapy, Social Work, Speech-Language Pathology and the Chaplaincy – is reviewing and updating its domain of practice.
Enhance communication with cutting-edge technology
Staff are equipped with specially programmed iPhones (also known as Voalté phones) that allow instant and discrete communication with other team members. Staff also have access to portable, durable laptops that provide secure access to shared information. Computerized whiteboards at the nurses’ station and whiteboards in patient rooms offer another clear and consistent method of communication.
Improve discharge readiness
A new discharge toolkit for patients and families, as well as a discharge follow-up phone call program, better prepares patients and families for discharge and help reduce hospital readmissions. Phone calls are made within 48 hours to all patients who agree to participate in the program.
Incorporate relationship-based care into hospital culture
The philosophy of relationship-based care emphasizes the importance of cultivating the relationship between the caregiver and the patient and family; the caregiver’s relationship with colleagues; and the caregiver’s relationship with him or herself. Many of the other interventions link back to this concept.
“In the coming weeks and months, we will learn a lot about health care innovation as we assess the impact of these interventions,” says Ives Erickson. “During the process, our best teachers will be our patients and families as they
share with us how we can best align our care practices to meet their needs and expectations.”
For more information about the Innovation Units, visit www.mghpcs.org/innovation_units.
The 12 Innovation Units
Lunder 9 Oncology
Bigelow 14 Vascular
White 6 Orthopædics/Maxillofacial
White 7 Surgical
Ellison 9 Cardiac ICU
Ellison 16 Medical
Ellison 17 and 18 Pediatrics
Blake 10 Neonatal ICU
Blake 11 Psychiatry
Blake 12 ICU
Blake 13 Obstetrics
Read more articles from the 03/30/12 Hotline issue.