4C Piloting Interdepartmental Shift Change

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Building a Patient-Centered Culture Unit by Unit

by PFCC Advisor Beth Konikoff

Any patient or provider will tell you that there is room for improvement in the patient’s hospital experience. But finding a way to operationalize those improvements is not an easy task. Hospitals have complex systems and patients have complex needs. How can the needs of both groups be met? Thanks to patient initiatives at UMHS, the answer is unit-by-.

On 4C, UBC Chair Katrina Tabor and her colleagues on 4C’s unit based committee (UBC) are championing various efforts to improve hospital efficiency while improving the patient’s experience. Standing with her is PFCC Patient Advisors (and former 4C patients) Jim Deters and Diane Stahle who help to provide patient insight to guide some of these improvements.

One of the key initiatives that has already been successfully adopted by 4C has been the use of bedside transfer between the day and night shift nurses. This new process has the current nurse and incoming nurse meet at the bedside with the patient, allowing all three persons to have the opportunity to discuss the patient’s care. This conversation allows everyone to hear the patient’s story, what has recently transpired and what will be occurring during the next shift.

Jim Deters, a high school principal by training, would always ask his students for input before implementing programs. He feels that the hospital should be no different. “We [patients] should participate in our own care. The hospital’s job is to heal me, but it is my job to be the best patient I can be so that I can help you heal me quicker!”

Based on the success of bedside shift change, the next initiative has begun to take shape: the bedside transfer of patients from the Cardiovascular Intensive Care Unit (CVICU) to the 4C step-down unit. The pilot they are undertaking is a forward-thinking collaboration between the two units.

By having the 4C nurse accompany the patient to the next unit, the same idea of being able to discuss the patient care from the current care-provider to the next with the patient, is underway. In addition to increasing patient engagement, bedside shift change across units strengthens communications and helps build positive staff relationships between two separate units that need to collaborate.

The bedside shift change approach offers many benefits for all parties. The patient benefits by actively listening, having the ability to ask questions and receiving immediate answers, ensuring what has been said has occurred, and participating in the care process. The nurses are able to review the patient’s status from the last shift and the expectations (or plan of care) going forward. They talk with the patient and develop a supportive team relationship, ensure safety checks and goals of care, and provide the patient with the confidence that they will be cared for consistently from shift to shift.

Of course, each unit has its own unique circumstances, which is why a unit-by-unit pilot approach to change is so important. A CVICU bedside transfer to 4C requires the 4C nurse to leave the floor and their patients while they accompany the patient to another unit. Therefore, coverage for their absence must be provided so that no patient is left unattended. The 4C UBC and CVICU UBC are working together so that with careful scheduling and planning, as well as a commitment to patient care, they will work to develop the best plan.

It was during Jim’s own departmental transfer from 4C to 6D where he noticed another opportunity for effective patient input. As nurses were coming in to demonstrate the technique for changing Jim’s bandage to his wife, each nurse was demonstrating a different technique. Unbeknownst to each nurse, they all thought they were doing it the same way. Thanks to Jim (and his wife) speaking up, a new procedure with visuals was implemented to ensure consistency and making the learning process easier for the homecare provider.

The effort of listening to the patient voice continues to grow and expand throughout the UMHS campus. Everyone from staff to patient to homecare provider is committed to the highest standard of care by including the very reason for care: the voice of the patient.

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