Releasing Time to Care - Towards Better Patient Care
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Releasing Time to Care Quality Forum February 27, 2014 Felicia Laing Sarah Suozzi Vancouver Coastal Health
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This presentation was delivered in session B1 of Quality Forum 2014 by: Felicia Laing Project Manager, Quality & Patient Safety Vancouver Coastal Health Sarah Suozzi Staff Nurse, Richmond Hospital Vancouver Coastal Health
Transcript of Releasing Time to Care - Towards Better Patient Care
Releasing Time to Care
Quality Forum February 27, 2014
Felicia Laing Sarah Suozzi Vancouver Coastal Health
Team members and sponsors
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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
The Releasing Time to Care (RT2C) teams
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Squamish General Hospital Richmond Hospital
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
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© Copyright NHS Institute for Innovation and Improvement 2007-2008
Foundation modules
Process modules
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!
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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
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After • Staff are taking
leadership roles
• Moved into more complex problems such as communicating daily goals with patients and their families
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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
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Engagement: Their own Vision Statements
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Core objectives
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
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Safety cross
Monitor falls based on the unit floor plans
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Meeting around the Knowing How We Are Doing Board
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“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
Falls: Main Reasons
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-Installing Y-connectors at each bed with bed alarms
- Safety checks during each shift
- White boards - Risk assessments on
admissions - Installation of motion sensor
lights - family education for fall
prevention
Falls Prevention – Actions Undertaken 1. Using toilet / commode
2. Attempting to stand
3. Getting in/out of bed / crib / stretcher
4. Walking without assistance, assistive device or equipment
Goal: Reduce falls by 50% by December 2013
Falls: Improvement actions and results
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Nov2012 Dec Jan
2013 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2013
Number of falls 12 9 4 1 3 5 6 4 6 5 4 6 4 6
0
2
4
6
8
10
12
Number of patient falls
Goal: To reduce to two falls per month by December 2014.
-Risk assessment on
-Families pamphlet on fall prevention -Motion-sensored lights in all rooms -Level of mobility on bedside white boards
-Safety audits every month
-Daily falls tracking on data board -Daily team huddles
-Regional implementation Falls Prevention program
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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, National Trauma Registry Analytic Bulletin Hospital Costs of Trauma Admissionsin Canada, 2000/2001. 2Can J Aging Volume 31, Number 2 (2012), p. 139-147
2 South
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
The Patient Kitchen
Before After
The Clean Utility Room Description Before After Walking Time 1169.3 935.7
# of Steps 2,104,701 1,684,176
Description Before After Walking Time 293.9 85.9
# of Steps 1,058,208 309,228
After Before
3 South – Hand hygiene
62 60 58
67 66
82
67
91
58
69 6763
57
74
85 82 81 82 81 79
91
7177
84
95
74
20
40
60
80
100
%
Before RT2C Median = 66.5% RT2C Average = 81.0%
3 South – Bedside rounds
• Involves patient & family in plan of care
• Interdisciplinary
• Connects the patient
to the whole team
Family
Patient
3 North Urinary tract infections
Staff experience
We’re achieving a new level of teamwork.
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.
Patient experience
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100.0%
96.6%
89.7%
96.4%
100.0%
0 20 40 60 80 100
During this hospital attendance/stay did you feel you were treated withdignity and respect?
Did you have good opportunity to participate in the decisions thatapplied to your care?
Did the doctors, nurses or other staff give your family or someoneclose to you all the information needed to help you during your stay or
treatment?
Did a member of staff explain the purpose of the medicines you wereto take at home in a way you could understand?
Were you provided with the equipment you needed to go home with?
Acute Care Patient Experience 2012 SGH Patient Feedback
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
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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
[email protected] Sarah Suozzi, RN Staff nurse and 2S RT2C Ward Lead
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Thank you
