Improving patient care at the bedside
At the pandemic’s onset, Anthony Staines, director of patient safety and quality improvement with the Hospital Federation of Vaud, Switzerland, met with quality and safety managers of 12 hospitals, to see how everyone was faring with their programs.
Their responses were sobering, he recalled. Half had been sent home by their CEOs, with advisement to “hibernate” their patient-safety program. The other half said their hospital had redeployed them to the intensive-care team to take advantage of their anesthesia or intensive-care skills. The result of all this: no one was left to do quality and safety work.
“If I’m a believer that quality and safety people have skills, then what can I suggest to them?” Staines said during a video interview with the Patient Safety Movement Foundation. Finding little in the clinical literature about strengthening these skills during extraordinary times, Staines reached out to colleagues in the field. The collaboration led to five primary strategies for optimizing patient safety and quality improvement staff during a pandemic.
In one key strategy, the experts said health systems should create opportunities to adjust rapidly and become more resilient. Staines acknowledged the challenges of meeting this goal when hospitals are dealing with higher-than-normal surges of patients they’re not equipped to handle.
“In that kind of time pressure, no one has time to feed incident reports into the information system,” he said.
A potential solution: enlisting a coordinator to capture crisis-related incidents. At the pandemic’s onset, Britain’s National Health Service had just two weeks to set up a COVID surge hospital of 4,000 beds, relying on a new set of personnel who hailed from London and beyond, and didn’t know one another.
Built inside a London convention center, the Nightingale hospital created a team of “bedside learning coordinators” to report on data about daily care. Stationed in each ward of the surge hospital, the coordinators gathered information about any quality and safety concerns during the day and in the evening met with hospital management and the quality and safety improvement department. This “deep briefing” ironed out any problems that arose in the ward.
Coordinators shared solutions with staff in the ward each day, leading to needed changes in standard operating procedures.
Maintaining such a coordinator over time might be difficult, given that it’s resource-intensive “You may not be able to keep them everywhere,” Staines said. To preserve the spirit and intent of this position, hospitals could downsize, placing coordinators in a few select wards of the facility.