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4 Right care at the right time: a care model redesign quality improvement project
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  1. William Bekker,
  2. Caitlin Garrett,
  3. Heather Gleason,
  4. Kathryn Hoehn,
  5. Katie Iommazzo,
  6. Karen Lane,
  7. Benji Mathews,
  8. Hilary Radtke,
  9. Sara Spilseth,
  10. Julie Weegman
  1. Regions Hospital

Abstract

Background Over the last several years, there have been focused efforts to continually improve communication amongst the care team while maintaining patient and family centered care, progressing the patient through their care as clinically indicated, and ensuring timely and efficient discharge planning. Despite these efforts, there was a lack of reliability in the care model which created gaps amongst care team members (inclusive of the patient) in the knowledge of the plan of care.

Objectives Care Model redesign is an approach aimed to decrease overall length of stay, improves workflow efficiencies that prioritize quality and timely care, and set a “gold standard” for hospital patient care. The goal of the inpatient care model was to improve both patient and staff satisfaction, while ensuring processes that support patient throughput and overall access to care.

Methods The Model for Improvement, best practice review, adaptive change management, human centered design tools, and PDSA cycles were utilized within the project. We created a new care model with structured connections and tools to support discussions. We engaged front line staff through a design session and optimized current technology to merge segmented work into one cohesive approach.

The new care model was initially piloted, evaluated, and spread to eight units across the hospital. The team leveraged a multidisciplinary coaching model, and consistent leadership presence to ensure engagement of all team members.

Results The data highlights reduced variation by creating a more reliable model to replicate. This resulted in a 21% rate of improvement, and we have exceeded the organization’s goal of 20% of discharges by 11:00am (figure 1). The team identified process, outcome, and balancing metrics for this project that were closely monitored and reviewed (figure 2).

Conclusions There is a continued commitment to follow the new process 7 days a week, identify opportunities and problem solve a patient’s plan of care as a team, and maintain high reliability. Communication and coordination amongst care teams and complex discharge planning has improved. Team members have demonstrated workflow efficiencies by being proximate to patients and each other.

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