- Educating about the proper use of VTE orders for post-operative patients
- Coordinating with pharmacists and other teams to ensure orders are followed
- Outlining how the Joint Commission's SCIP guidelines can help improve compliance
What can your team do to work with other teams to improve outcomes for patients?
- Creating a wait list for patients who need to schedule surgeries
- Assigning a full-time employee to manage the wait list
- Using openings in the schedule to squeeze in emergency patients
What can your team do to improve patient satisfaction and efficiencies in your department? What else could your team do to relieve scheduling backlogs?
Getting joint replacements patients in and out of the hospital swiftly is good for the patients and good for Kaiser Permanente--but is a major departure from past practice. See how this unit-based team stepped up to address staff concerns and keep morale high.
The new goal was dramatic: Reduce hospital stays to 23 hours for total joint patients.
Renee Portillo, RN, was worried.
“It was a shocker. Our staff was used to patients going home in two to three days,” says Portillo, former assistant clinical director and management co-lead of the 7 South medical-surgical team at Fontana Medical Center in Southern California.
The accelerated time frame meant that the unit’s nurses, who care for total joint patients following surgery, would have less time to prepare them for discharge. They’d also need to help choreograph care across multiple departments—Orthopedics, the operating room, Physical Therapy, Home Health—from pre-admission to discharge.
Who best to help the team through this change? The team itself.
“We used our UBT to help change the culture,” Portillo says.
Wave of the future
“We helped our nurses be successful by having them anticipate patients’ needs and prepare them for discharge,” says Enrique Rivero, RN, a surgical nurse and UNAC/UHCP member who is the team’s union co-lead.
Fontana is among a growing number of hospitals across the United States to offer a combination of shorter hospital stays and more outpatient care for hip and knee replacement patients. The trend is driven by less-invasive surgical techniques, improved pain management and rehabilitation practices, and patients’ desire to return home as soon as possible.
“There were a lot of challenges. A lot of it had to do with bringing people together,” says Mary Hurley, MD, chief of Orthopedics, who championed the new approach. “They all had to buy in and be willing to support this in order to have a successful program.”
The new approach, which Fontana introduced in January 2014 after months of researching best practices, gets patients walking within hours of surgery and enables them to recover within the comfort of their own homes. The initiative takes advantage of Kaiser Permanente’s integrated model of care and is designed to improve clinical outcomes and reduce costly hospital stays.
Shorter hospital stays for joint-replacement patients helps to:
- improve clinical outcomes, and
- reduce costly hospital stays.
It also gets patients where they want to be—home.
Watch how this UBT got together to make it work.
A team in South San Francisco that improved the surgery-scheduling process for patients and teams in San Diego that took a hard look at their service scores demonstrate what things look like when teams truly consider what's best for the patient as they make decisions.
What happens when teams truly walk a mile in their patients’ shoes? They often discover their own actions are making that mile a rocky one for patients—and as a result make huge breakthroughs in the way they deliver care.
In the case of South San Francisco’s multidepartmental pre-admission team, observing their processes from the other side of the gurney spurred them to dramatically streamline the pre-surgery and admitting process for patients. With the member at the forefront of their thinking, the team members turned a two-inch-thick packet of confusing, redundant information into a streamlined, one-page checklist. And a funny thing happened—while redesigning the process to help patients, the team improved the way it works.
“Patients would often get confused and weren’t sure what the next step in the process was,” says Brian Tzeng, MD, the Peri-operative Medicine director. “We realized we didn’t have a clear path for the patient to follow.”
Other teams throughout Kaiser Permanente are making similar realizations, framing their performance improvement work by asking the question, “What’s best for the patient?” If a possible solution doesn’t work well for the member and patient, then there’s more brainstorming to be done. These teams are taking the Value Compass to heart—organizing their work not just around the four points but examining what they’re doing from the patient’s perspective.
What does that mean for frontline teams? At the San Diego Medical Center, the Emergency Department sees up to 300 patients every 24 hours. Physicians and staff members are always on the go, delivering on the ultimate bottom line—saved lives. What could be more important? Clinical quality is high; patients are seen in a timely manner and the rate of unscheduled return visits is good.
Yet the results of a recent patient satisfaction survey bothered the team. The department scored well overall, but their patients gave it only 63 percent approval on one question: While you were in the Emergency Department, were you kept informed about how long the treatment would take?
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Streamlining the process: The new pre-surgery checklist developed by a South San Francisco UBT has helped patients and improved communication for everyone involved. Dr. Brian Tzeng (center) helped lead the work.
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Improving service: Terry Caballero, a surgery scheduler and SEIU UHW member, helped spark the work that led to a streamlined surgery-scheduling process.
In South San Francisco, Dr. Brian Tzeng, who’s an anesthesiologist, and others on the team say that working on the project through the unit-based team allowed them to understand each others’ roles and responsibilities better—and also gave them an opportunity to hear and contribute an opinion from that perspective.
“One of the great benefits of this group was it was an outlet for multiple providers at different levels to voice their concerns and actually be heard,” Dr. Tzeng explains. “The greatest frustration for many individuals is we all had great ideas but didn’t know how to make that happen. We realized through this group we had a means to make those changes.”
Dr. Tzeng is certain the team’s accomplishments are the result of every team member’s commitment to working out the best solution in the patient’s best interest. There were no politics, just concern for the member.
“To us, this is not a job,” says Debbie Taylor. “We come here to serve a patient.”
And what about Caballero’s initial concern, that patients weren’t getting enough advance notice about when they have to be at the hospital? The team has been slowly chipping away on that as well. In October, they expect to start giving patients two days’ advance notice of their arrival time at the hospital.