Innovation Units Underway
By Teresa Buchanan, MBA, RN, Project Manager
The Partners Patient Affordability Initiative is focused on improving the effectiveness and quality of care while positively impacting efficiency and cost. To help achieve this, Partners hospitals have been asked to test new and creative care delivery models and ideas through “innovation units.”
In August, Jackie Somerville, PhD, RN, senior vice president of Patient Care Services and chief nursing officer, and Stan Ashley, MD, chief medical officer, put forth a call for innovation unit proposals. They asked that innovation units incorporate concepts of provider continuity, an inclusive environment and patient/family centered care. Other key components might include a unit-based care coordinator, standardized methodology for hand-offs across the care continuum and consistent interdisciplinary rounds.
The innovative model needs to be accomplished utilizing existing resources, though teams are empowered to examine and reconfigure existing roles and resources. In addition to project-specific measures, positive outcomes in all projects would be evidenced by one or more of the following metrics: reduction in 30-day readmissions, preventing avoidable ED visits, decrease in length of stay and improvement in patient and staff satisfaction. The ultimate outcome would be that as effective strategies are identified, they are shared and spread across patient care areas.
Seven projects were selected, five of which have already begun implementation with the remaining two expected to launch later in 2012. The projects are detailed below.
SH 6/7: Interdisciplinary Care Model of the Complex Cardiac Surgery Patient and Family
By Justin Precourt, MSN, RN
The Cardiac Surgery Innovation project addresses the needs of post-cardiac surgical patients identified as “chronic critically ill.” A weekly multidisciplinary meeting including all relevant team members is conducted and geared toward meeting the unique needs of these patients. As a result, care plans are generated that lead to better team communication, earlier stabilization of medical issues and a shorter acute care hospital stay. This translates into improved clinical outcomes, cost savings and patients being able to move onto the next stage of recovery, whether that is in a rehabilitation setting or home.
16AB: Total Hip Replacement Care Redesign
By MaryAnne Kenyon, RN
This work has been a multidisciplinary effort representing all aspects of care for patients undergoing hip replacement. Through this effort, clinical management of the patient has been standardized, including preemptive pre-operative pain management, enhanced physical and occupational therapy, and standardized mobilization by nursing, all leading to a shorter hospital stay and lower costs. Enhanced communication between team members, patients and families, comprehensive pre-operative and post-operative education, and improved discharge coordination contribute to a better prepared patient and family, both during hospitalization and post-discharge, and improved patient satisfaction.
Intensive Palliative Care Unit (IPCU), Palliative Care Medical and Nursing Collaborative Practice
By Eileen Molina, RN
The IPCU team provides specialized care to patients requiring symptom management and/or end of life care. Patients on this “virtual unit” are geographically located throughout the hospital, so a designated nurse role was piloted to measure the impact of a consistent nursing presence on the IPCU team and identify existing gaps. During this pilot, the nurse participated in daily interdisciplinary rounds, acting as a liaison between Nursing and the IPCU team and a consultant to nurse colleagues around the plan of care. As this project leaves the pilot phase, strategies are being developed at the unit level to address opportunities identified. It’s the team’s belief that consistent nursing presence on the care team translates into reduced readmissions, unnecessary tests and shorter hospital stays; improved patient and family outcomes; and a better overall experience for patients, family and staff.
Tower 14: Improving the Quality and Safety of Care Transitions
By Pat Aylward, RN
Tower 14’s project started as an IHI STAAR initiative focused on
reducing readmissions and, by participating as an innovation unit, Tower 14 is implementing expanded strategies. These strategies include effectively documenting and teaching the primary learner; creating an educational plan of care utilizing teach back and focused teaching; working with the pharmacy department to identify high-risk patients and augment medication reconciliation; piloting unit coordinator post-hospitalization patient/family focused appointments on 14D; warm-handoffs to Spaulding facilities, Partners Home Healthcare and other facilities; and discharge rounding on 14D and soon 14C.
Tower 8: Interdisciplinary Team Collaboration and Care Coordination
By Peter Keenan, RN, and Cheryl Ventola, RN
This project is focused on improving patient outcomes, satisfaction and care transitions, and reducing 30-day readmissions through improved team collaboration and coordination. Key components of this innovation unit include unit-based care coordination and social work, warm hand-offs, interdisciplinary rounding and scheduling of post-discharge follow-up appointments. They have also introduced integrative care components such as music and Reiki sessions to enhance the healing environment and support patients, families and staff. Other strategies to achieve goals, such as incorporating pain and palliative consults and end of life discussions, into patient care planning are being implemented.
CWN-9: Innovation Project
By Miriam Trainer, RN , Annie Lewis-O’Connor, PhD, RN
The CWN-9 team is designing a new model of care built around the desires and wishes of the patient and family. The goals of this innovation project are to improve the patient experience and discharge process, and improve communication and coordination among the inpatient and outpatient care teams. Strategies include use of text messaging to educate patients and families prior to delivery and development of tools to facilitate communication between the patient, family and health care team. This project is expected to begin in March 2012.
SH 9/10: Transitioning Home: Nurse Practitioner-led Program for Heart Failure Discharges
By Michelle Young, NP, Joanne Weintraub, NP, and Carol Flavell, NP
Building on their work to date, the heart failure nurse practitioners plan to work with the team to further reduce 30-day readmissions and avoidable ED visits, as well as improve patient satisfaction with the discharge process. This will include development of a discharge checklist, reconciliation of pre-admission and post-discharge medications, ensuring medication availability in the community and post-discharge follow-up call. The nurse practitioners will also see these patients in clinic post-discharge if they are followed at BWH. This project will launch in 2012.