Teamwork Eases Pain of Change
UBT members stepped up to address staff concerns and keep morale high following the adoption of a new approach to caring for total joint patients.
Faced with a major change in protocol, this med-surg UBT united to help its patients—and its own staff
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.”
丰塔纳经过几个月的最佳实践研究，于2014年1月推出了这种新方法，让患者在手术后的几个小时内行走，并让他们能够在舒适的家中恢复。该计划利用Kaiser Permanente的综合护理模式，旨在改善临床结果并减少昂贵的住院费用。
有很多挑战。很大程度上是为了让人们团结起来。他们都必须接受并且愿意支持这样才能有一个成功的项目。
Identifying top concerns
As it considered the new approach, the 7 South unit’s top concern was patient safety and pain management.
To address those issues, the representative UBT’s eight members—mostly nurses—met with Vicki Kreps, RN, the clinical supervisor of the Home Health department. Kreps’ team of registered nurses and physical therapists help care for patients after discharge.
The meeting resulted in Kreps attending the 7 South team meetings for three months.
“It helped build bonds of trust with the inpatient nurses,” Kreps says. “That trust is so significant.”
Once implementation started, charge nurses committed to making post-discharge calls to patients and then shared updates during department huddles.
“出院电话真的很有帮助，”现在河滨医疗中心家庭医学助理部门主管波蒂略说。这些更新给了护士信心，让他们相信病人在家里过得很好，并使他们成为新方案的积极支持者。
Success on every level
The team’s representative members helped their colleagues adapt to the new approach in other ways as well. When nurses were concerned about pain management, the representative members invited a pharmacist to speak with the rest of the team. UBT representatives also coached nursing staff on managing patients’ expectations and preparing them for early discharge.
The hard work is paying off. Between January and November 2015, Fontana performed 974 hip and knee-replacement procedures. About 64 percent of total joint patients were discharged within a day of surgery. Quality remains high: As of the second quarter of 2015, there was one hospital readmission within 30 days of discharge and no service recovery issues. The new approach is cost effective, too, producing $1.2 million in hospital savings during the first year.
Being deeply involved in decisions affecting their work helped the department’s 62 employees embrace the new model of care.
“我们的单位之所以成功，是因为我们的UBT给了我们一个机会，告诉其他人什么是有效的，什么是无效的，”UBT成员克里斯蒂娜·库克(Christina Cook)说，她是一名移动技术人员，也是美国钢铁工人联合会(United Steelworkers Local 7600)的成员。“它让每个人的声音都有机会被听到。”
See Team Members in Action
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.
看看这个UBT是如何团结起来让它工作的。
savings by medical-surgical team in Fontana after following new joint-replacement surgery discharge protocol