SIGNS OF SUCCESS: Length of stay on the Innovation Units has decreased by an average of 5 percent since March.
More than six months after the launch of the Innovation Units – 12 inpatient units serving as testing grounds for strategies to improve patient outcomes, enhance patient, family and staff satisfaction, and reduce costs and length of stay – enough data are now available to start evaluating the success of the interventions tested (see sidebar).
“Early findings have been positive,” says Jeanette Ives Erickson, RN, DNP, FAAN, senior vice president for Patient Care and chief nurse. “Our creative thinking is making a difference. We’re encouraged by the impact the Innovation Unit interventions are having on interdisciplinary teamwork and communication, patient and family satisfaction, length of stay and readmission rates. An evaluation of the units is being conducted by staff in the Center for Innovations in Care Delivery and the Yvonne L. Munn Center for Nursing Research. Quantitative metrics being tracked include statistics about length of stay, readmissions, quality indicators, cost per case mix and staff retention, as well as the results of patient and staff satisfaction surveys such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) tool and the Revised Staff Perceptions of the Professional Practice Environment scale. Qualitative metrics include focus groups comprised of staff, patients and families, as well as observations and narrative reports.
Early data for what may be two of the most significant interventions – introducing the new role of attending nurse and hardwiring into practice the philosophy of relationship-based care, which emphasizes the connection between patients and providers – point to success.
Innovation Units interventions include:•
• Introducing the new role of attending nurse
• Improving hand-over communication
• Enhancing preadmission data collection
• Encouraging dialogue through a new “Welcome Packet,” including the Patient and Family Notebook and Discharge Envelope/Checklist
• Building awareness of domains of practice
• Implementing regular interdisciplinary rounds
• Increasing use of cutting-edge electronic devices
• Introducing whiteboards in patient rooms and electronic whiteboards at nurses stations
• Developing a standardized discharge checklist
• Implementing a Discharge Follow-up
• Creating strategies to reduce noise
“Staff consistently describe the ‘importance of embracing the philosophy of relationship-based care to guide care delivery,’” says Jeff Adams, RN, PhD, director of the Center for Innovations in Care Delivery. “In addition, the attending nurse role was embraced by all role groups and disciplines and was described by many as ‘a significant innovation.’”
Jean Stewart, RN, attending nurse on the White 6 Orthopædics Unit, describes her role as the “constant” nurse. “I’m the one who’ll be there every day assisting patients, families and staff with whatever is on their minds. I help keep the patient’s hospitalization cohesive and moving forward.”
In addition, at a recent Innovation Units retreat, Dorothy Jones, EdD, RNC, FAAN, director of the Munn Center, reported that hand-held devices to facilitate communication were especially well-received, although other technologies posed challenges and warrant additional study. Jones also noted that length of stay – which decreased on the Innovation Units by 5 percent as of early November – and HCAHPS data demonstrate a “statistically significant positive response to changes on Innovation Units.”
Rick Evans, senior director of Service Excellence, – whose department coordinates efforts to improve the patient experience and the hospital’s HCAHPS scores – explains that HCAHPS is a tool used to regularly survey patients about their perceptions of care. “This year, the scores on the Innovation Units have risen at a rate exceeding the already impressive overall hospital rate,” Evans says.
All of this information is being tracked via the recently developed Innovation Units Dashboard, which provides an at-a-glance view of trends in data compared to benchmarks. The dashboard includes quality and safety data – fall rates, pressure ulcer statistics and restraint utilization – as well as infection control, length of stay, readmissions, patient satisfaction, staff satisfaction, patient volume and financial statistics.
“The Innovation Units Dashboard demonstrates unit performance for key metrics for a baseline measurement period,” says Amy Giuliano, senior project manager in the Patient Care Services Office of Quality and Safety. “Measures and benchmarks are updated quarterly, reflecting outcomes and performance during the period when each intervention is rolled out.”
The most recent Innovation Units Dashboard, along with other details and resources about the units, is available at www.mghpcs.org/innovation_units.
“Looking ahead, we plan to roll out to all inpatient units those Innovation Units interventions that are proving successful,” says Ives Erickson. “By sharing best practices and standardizing whenever possible, we’ll continue to improve systems, refine care delivery, and mine the creativity and innovative thinking that has brought us so far.”
Read more articles from the 11/16/12 Hotline issue.