Hospital Care
Truman Medical Center-Hospital Hill in Kansas City, MO, is an urban non-profit hospital with an ED flow of 62,000 patients. Like many EDs, Truman frequently tells its patients who received sutures to return five to seven days later to have them removed. These patients often had to wait long periods of time for this simple procedure. The facility aimed to improve its turnaround times for these patients by creating more efficiency in their suture removal protocol. The goal was to reduce door to discharge to less than 20 minutes in more than 90 percent of its wound and suture removal...
St. Elizabeth Healthcare-Edgewood in Cincinnati, OH, is a non-profit suburban hospital seeing about 77,000 emergency department (ED) patients per year. The ED recognized a significant barrier to quality and efficiency in the care of admitted patients was driven by suboptimal communication and accountability for patient handover and transfer issues. When the ED called to report on a patient, the floor nurse wasn’t available. When the floor nurse called back, the ED nurse wasn’t available. This form of “telephone tag” occurred daily and was frustrating to all staff...
Eastern Maine Medical Center placed "Blue Feet" along the corridors of their TCAB pilot unit to help patients know how far they are walking. Patients are often asked to walk a specific distance a specified number of times each day as part of their treatment plan. The "Blue Feet" help patients know exactly how far they have walked. This is an easy and inexpensive intervention developed by the staff on EMMC TCAB unit.
Impact
Crowded waiting rooms and long waits cause ED patients to leave the ED before being seen by a physician. Research has shown that some of the patients who leave have a serious medical problem that often gets worse before they are finally seen. By creating a Fast Track, a streamlined care pathway for low acuity patients, St. Elizabeth-Florence in the Cincinnati Alliance was able to reduce their Left Before Being Seen rate from 2.5% to 1.2% . This represents a 52% improvement!
Voices
‘“The beauty of TCAB is that quality becomes practical in the hands of bedside nurses who are given the tools to conduct small tests and change, then adapt, adopt, or abandon those tests until an innovation becomes a new way of doing things,” said Judy Warmuth, RN and Wisconsin Hospital Association vice president of workforce. In the Beloit Daily News in Wisconsin April 23, 2011.
Hospitals need to act to improve safety and reliability of care. AF4Q’s Hospital Quality Network connects 120 hospitals across the 16 Aligning Forces communities to implement, measure, and spread innovative strategies to improve the quality of hospital care. HQN hospitals are reducing readmissions, improving language services, and increasing throughput of emergency departments.
Six regions nationwide participate in AF4Q’s Transforming Care at the Bedside (TCAB) program, which taps nurses and care team members who spend the most time with patients and their families for ideas for transforming the way care is delivered on medical/surgical units.
AF4Q’s Transforming Care at the Bedside is making a difference across the country by empowering nurses to make real change.
From The American Journal of Nursing: Several years ago Bonnie Glica, MS, RN, senior vice president of nursing at Erie County Medical Center in Buffalo, New York, began to understand why nurses at her facility weren't at the center of quality improvement efforts in areas such as pressure-ulcer reduction: they were waiting to be told what to do.
"Some staff would wait to take direction from nursing administration," she said recently, "rather than ask each other, 'What are we seeing today, and what can we do to make it better?'" …
“We go in with the training, create the agenda, bring the materials, said [Catherine] West. “We want to build infrastructure so that when Aligning Forces goes away they don’t just stop.” Catherine West, MS, RN is the quality improvement leader for Transforming Care at the Bedside at the AF4Q National Program Office.
For more information: http://www.hospitalcompare.hhs.gov