Case Study: Team Effort Drives Down LOS, Increases Quality of Care
As expectations about patient safety and length of stay (LOS) gain importance in the current health care environment one effort in Thoracic Surgery has gained significant momentum. An initiative led by Chief of Thoracic Surgery David Sugarbaker, MD, and others from the Thoracic service line, has successfully decreased length of stay (LOS) over time. The team effort has also improved quality of care and patient safety.
The Thoracic Care Improvement Team, comprised of physicians, nurses, case managers, physical therapists, respiratory therapists, dieticians, PCAs and unit associates, has been successful in lowering Thoracic Surgery LOS to 7.07 in FY 03 (through May). This represents a 12 percent decrease from the FY 02 average, which was 8.07 days. These efforts, and others around the hospital are helping to further reduce the hospital’s current LOS of 5.45 days, which will continue to enhance quality of care and patient safety hospitalwide.
Clinical Care Pathways have assisted the team and all staff of the service line to appropriately treat each patient and properly prepare him or her for discharge in the correct time frame. The specific pathway is chosen based on the patient’s surgical procedure; however once a pathway is chosen, staff know when to expect discharge, so that date can be communicated to the entire patient care team and the patient’s family.
“Our pathways have been key to standardizing care of Thoracic patients. Not only do the paths ensure consistent high quality care for all Thoracic patients, but they make hospital stays run smoother for the caregivers and patients,” said Sugarbaker.
Another important initiative on Tower 11 is the day-after-discharge (DAD) calls. Care Coordination takes a leading role with these calls and also works with the family to select a facility to which the patient will be transferred after discharge. Case managers Ann Higgins, a former Thoracic staff nurse, and Debbie Cartwright exclusively handle thoracic patients.
In addition to the ongoing facilitation of care, the nurses on Tower 11 make sure measures that need to be taken prior to discharge are completed, such as discharge x-rays. Under the initiative, the expected reading and reporting of discharge x-rays ensures that patients do not have a partially collapsed lung due to chest tube removals. The nurse is able to speak directly to the radiologist, thereby avoiding delay on the results and a longer wait for discharge.
Recent reports from the second quarter indicate Thoracic patients are being sent home on or before the expected day of discharge. The exception to this is patients who remain in the hospital due to a medical condition. “These results are reassuring that our efforts are continuing to pay off for the patients and BWH,” said Mae Hansen, RN, nurse manager, Tower 11.