| Primary Author: | Sandi Gill, BSN, RN |
| Co-Principal Investigators/Collaborators: | James Farmer, BSN, RN, MS, CCRN |
| Organization | Medical Center of Plano |
Abstract
Problem
ICU Stepdown was experiencing prolonged patient discharge time, increased length of stay, and decreased patient satisfaction.
Evidence
Literature shows that when teams collaborate on the patient plan of care and discharge planning in a formalized daily process, improved patient outcomes, satisfaction and timely discharges occur. In the literature, we were unable to locate specific research regarding nursing units outside of critical care units.
Strategy
The ICU Stepdown manager took the evidence based concept of crticial care multidisciplinary rounding to the unit council and proposed an adapted form into the existing daily huddles. The unit council recommendaed that information from huddles be documented, updated daily, and available to all members of the health care team. The most effective way to communicate this information would be on dry erase boards in each patient room. The information to be documented included discharge planning, nursing sensitive indicators, core measures, fall risk, outstanding tests, and PT/OT/ST needs.
Practice Change
To change practice, the multidisciplinary team was educated on the new daily huddles. During the implementation phase, the manager led the huddle to role model for the staff and the assistant nurse managers to ensure information was targeted and streamlined toward achieving the patient’s goals. This process allows the nursing staff to improve critical thinking skills, anticipate discharge needs, pay attention to core measures and nursing sensitive indicators, develop the plan of care for the day, and alert the nurse manager to potential issues.
Evaluation
The metrics utilized to evaluate success of the program were patient and nurse satisfaction scores, nursing sensitive indicator and core measure outcomes, and number of patients discharged prior to 11:00 a.m. All metrics improved significantly over the 12 months.
Recommendations
Our organziation has adopted this as best practice to be utilized on all adult inpatient units.
To incorporate as many other disciplines as possible to participate in the huddles.
Lessons Learned
This can be expanded to include wide variety of topics and be unit specific to meet the needs of the patient population.
The manager needs to stay involved periodically to ensure the process remains focused.
Provide a template for the assistant nurse manager to lead the huddles in an efficient manner.
Bibliography
Burger, C.D. (2007). Multi-Disciplinary Rounds: A Method to Improve Quality and Safety of Critically Ill Patients. Northeast Florida Medicine, 58(3), 16-19.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).