Front-line nurses lead charge to standardize inpatient care

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.