Front-line nurses lead charge to stan­dard­ize in­pa­tient care

Modern Healthcare - - NEWS - —Shelby Liv­ingston

In 2014, Philadel­phia-based Thomas Jef­fer­son Univer­sity Hospi­tal was deal­ing with sig­nif­i­cant clin­i­cal vari­a­tion across in­pa­tient units, lead­ing to in­ef­fi­cient nurs­ing teams and worse pa­tient out­comes. So the next year, a team of front-line nurses, along with physi­cians and other staff, de­signed and im­ple­mented a stan­dard­ized in­pa­tient-care model that fo­cused on strong unit lead­er­ship and col­lab­o­ra­tion among nurses and physi­cians at three of Jef­fer­son’s hos­pi­tals.

As a re­sult, Jef­fer­son elim­i­nated nearly 8,200 un­nec­es­sary hospi­tal days in a 12-month pe­riod, lead­ing to sav­ings of $7.7 mil­lion.

“We felt that any­thing that would re­sult in pos­i­tive, sus­tain­able change would have to be at the bed­side,” said Mary Ann McGin­ley, se­nior vice pres­i­dent for pa­tient care and chief nurs­ing of­fi­cer. As the one dis­ci­pline al­ways at the hospi­tal, nurses led the charge, she said.

The mul­ti­step in­ter­ven­tion be­gan with cre­at­ing lead­er­ship teams, com­posed of a nurse man­ager, med­i­cal di­rec­tor and case man­ager, for each of the 44 nurs­ing units that worked to­gether to co­or­di­nate care, mea­sure out­comes and iden­tify ways to im­prove pro­cesses.

Care teams be­gan hold­ing daily mul­ti­dis­ci­plinary rounds to dis­cuss care plans, pa­tient mile­stones and dis­charge plans. They also de­vel­oped clin­i­cal pro­to­cols based on out­comes for dif­fer­ent con­di­tions. Beds were re­as­signed so pa­tients with sim­i­lar con­di­tions were placed near each other for im­proved ef­fi­ciency. The case-man­age­ment process was re­vamped, and fi­nally, care teams be­gan hold­ing quar­terly meet­ings to re­view per­for­mance and mon­i­tor out­comes data.

“The en­gage­ment, the team­work, the col­lab­o­ra­tion across dis­ci­plines, and get­ting out of the si­los is re­ally es­sen­tial,” said Brian Sweeney, a nurse and se­nior vice pres­i­dent of hospi­tal op­er­a­tions.

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