Published on March 7, 2014
Releasing Time to Care Felicia Laing Sarah Suozzi Vancouver Coastal Health Quality Forum February 27, 2014
Team members and sponsors Jacquie Miller Audra Leopold Sarah Suozzi David Taylor Kirsten Poulsen Jillian Schulmeister Susan Choi Kenna-Leigh Kurtz Sara Fatehifar Lindsay Fraser Rowena Bakker Natalie Shein Alicia Escobido Jill McDougall Nancy Haffey Cindy Klaver Karen Young Lindsay McArthur Veronica Fincham Norm Greenway Silvia Nobrega Melanie Rydings Cindy Sellers Gail Malenstyn Andrew Tung Lorelei Grosser Felicia Laing Laurie Leith Claude Stang Wendy Hansson Mike Nader Susan Wannamaker Linda Dempster Johanne Fort Monica Redekopp Rena van der Wal Sandie Kocher Sue Golding Carolle Sauro Stefanie Raschka Ruby Gill Corrina Hayden 2
The Releasing Time to Care (RT2C) teams Squamish General Hospital Richmond Hospital 3
Goals of the demonstration project 1. Improve teamwork among staff 2. Decrease interruptions and work flow inefficiencies 3. Increase direct patient care time 4. Improve patient satisfaction 5. Decrease patient adverse events and infection rates 6. Demonstrate financial efficiency
Productive ward Releasing time to care • Structured program with modules designed to guide you through the processes • Efficiency guidelines to achieve significant and lasting improvements, thereby allowing extra care time for patients • Tested and proven to be successful in many health care settings: – – – – Ontario, Manitoba, BC US, CareOregon UK, Sweden, European countries Australia, New Zealand
RT2C program Process modules Foundation modules © Copyright NHS Institute for Innovation and Improvement 2007-2008 6
Before • Leadership was de-energized • Basic nursing care such as mobilization, bathing, and mouth care NOT consistently done • Staff did not feel supported to change • Staff were not accountable for their decisions nor were they creative and innovative in making things better • Status quo was ok! 7
After • Staff are taking pride in their work • Now performing good basic nursing care • Take ownership of a problem and work to solve it in a creative manner 8
After • Staff are taking leadership roles • Moved into more complex problems such as communicating daily goals with patients and their families 9
The team • Ward Lead – bedside nurse dedicates one shift a week • Engagement of all staff • Manager & Senior Leadership supports and remove barriers for the team • Core support – Quality & Patient Safety, Lean, Professional Practice, BCNU
Engagement: Their own Vision Statements 12
Core objectives 13
A Journey through RT2C: Patient falls
Before RT2C: impact of falls • • • • 12 to 15 falls per month Costly Time-consuming for nursing staff Harmful to patients
Safety cross 16
Monitor falls based on the unit floor plans 17
Meeting around the Knowing How We Are Doing Board “Our daily team meet gets us talking about the reasons WHY things are the way they are – and how we can make it better.” - Staff Nurse 19
Falls: Main Reasons 1. Using toilet / commode Falls Prevention – Actions Undertaken -Installing Y-connectors at each bed with bed alarms 2. Attempting to stand - Safety checks during each shift - White boards 3. Getting in/out of bed / crib / stretcher 4. Walking without assistance, assistive device or equipment - Risk assessments on admissions - Installation of motion sensor lights - family education for fall prevention Goal: Reduce falls by 50% by December 2013 20
Falls: Improvement actions and results 12 Goal: To reduce to two falls per month by December 2014. -Daily falls tracking on data board -Daily team huddles 10 -Families pamphlet on fall prevention -Motion-sensored lights in all rooms -Level of mobility on bedside white boards 8 Number of patient falls -Safety audits every month 6 4 -Regional implementation Falls Prevention program 2 -Risk assessment on 0 Number of falls Nov 2012 Dec Jan 2013 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2013 12 9 4 1 3 5 6 4 6 5 4 6 4 6 21
Falls: Projected Cost-Avoidance • Three wards could reach a cost avoidance of $802,134 by reducing their falls by 50% • 560 bed-days could be prevented due to an extended length of stay (LOS) Based on (1,2): • Total extended LOS for serious falls = 34 days • Extended LOS for minor falls = 5 days 1CIHI, 2Can National Trauma Registry Analytic Bulletin Hospital Costs of Trauma Admissionsin Canada, 2000/2001. J Aging Volume 31, Number 2 (2012), p. 139-147 22
2 South – Bedside charting • In-the-moment charting • Worked with interdisciplinary staff • Keep staff closer to patient’s bedside • Better recall
Squamish – Well organized ward Before After Before The Patient Kitchen After The Clean Utility Room Description Before After Description Before After Walking Time 1169.3 935.7 Walking Time 293.9 85.9 # of Steps 2,104,701 1,684,176 # of Steps 1,058,208 309,228
3 South – Hand hygiene 100 91 85 82 80 % 60 62 60 58 67 66 69 67 67 58 74 63 95 91 84 82 81 82 81 79 71 57 40 Before RT2C Median = 66.5% 20 RT2C Average = 81.0% 77 74
3 South – Bedside rounds • Involves patient & family in plan of care • Interdisciplinary Family Patient • Connects the patient to the whole team
3 North Urinary tract infections
Staff experience We’re getting people [nurses] to think in a different way, utilizing the process and monitoring the results. There is always room for improvement. The awareness how the small things we can do will make a difference. We treat all patients the way we want to be treated and RT2C gives us a tool to have more time for the patients. We’re achieving a new level of teamwork.
Patient experience Were you provided with the equipment you needed to go home with? 100.0% Did a member of staff explain the purpose of the medicines you were to take at home in a way you could understand? 96.4% Did the doctors, nurses or other staff give your family or someone close to you all the information needed to help you during your stay or treatment? 89.7% Did you have good opportunity to participate in the decisions that applied to your care? 96.6% During this hospital attendance/stay did you feel you were treated with dignity and respect? 100.0% 0 Acute Care Patient Experience 2012 20 40 60 80 100 SGH Patient Feedback 30
Lessons learned • Long journey – years for culture change • Leadership engagement needed for staff engagement • Improvements should be made with interdisciplinary staff • Weekly updates from Ward Leads promotes communication throughout all levels • Balance between strategic goals and frontline initiative • Balance between pace and improvement 31
Next Steps • • • • • Spread RT2C beyond the 4 pilot sites Patient-centred care Sustain changes Physician engagement Implement: – The productive operating theatre – Releasing time to care – Mental Health
Contact Information Felicia Laing, MSc Regional Project Manager – Quality & Patient Safety firstname.lastname@example.org Sarah Suozzi, RN Staff nurse and 2S RT2C Ward Lead email@example.com
Thank you 34
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