Care Progression

In this episode, we will be speaking with Sam McGowan and Kristie Butterworth about our Care Progression Leaders, The Hub, and CDU. 

Transcript

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Welcome to Nursing Together. I'm Michelle Hohen, Tanner C N E, and your host. We welcome back Sam McGowan and Christy Butterworth to talk about our care progression journey and the new role of our care progression leaders. In this episode, we are going to give important information the role of our CPLs and how they work in our care progression rounds. So welcome. We are so happy to have you guys back. Can you please describe the roles, what they do and the importance of the role of our CPLs? Sure, I'll take that one. So our care progression leaders is a new role at Tanner that came about through our care logistics, our care compass project to improve efficiency and create additional capacity at our Carrollton and Villarica campuses. So initially we had designed this role to be our inpatient clinical coordinators, or ICCs. So they were to lead our care progression rounds and own progression. What we quickly realized is that progression is a job that is continuous and ever evolving, and there does need to be a constant focus on that. And we were pulling our ICCs away from supporting the staff on the floors. And Working with Michelle, we made the decision to actually separate this out into a new role. So a care progression leader is truly that owner of patient progression on the unit. They are assigned specific units. They do float through Carrollton and Villa Rica. And that was to one, have a fresh perspective on our long length of stay patients and, to catch near misses or issues where something may have just been forgotten or missed for the patient. And then also just to really own that progression and make sure that we're not having that. Loyalty, I guess isn't, I don't want to say loyalty, that allegiance to that unit, say if they had a really bad day yesterday, I don't want to push Yeah, I agree. Sometimes this can happen when we get too comfortable on our units and we start getting comfortable with the same type of reasonings why we can't progress a patient or why we can't get something done for a patient or really why the patient just can't go. So I agree with you. This is why it is so important to have a fresh perspective to ensure that we are looking at all of our obstacles and objectively looking at them in a standardized way. Exactly. So, the goal of their role is. to ensure that our patients are progressing. It's not about pushing patients out or kicking anyone out of the hospital too soon. We do regularly monitor our readmission rates and watch for any kind of safety issues. But it's to do what's best for the patient to make sure that we're decreasing that waste time due to lack of coordination or delays for our patients. They really should be the center point of communication across the unit. They're working very closely with our A& M's on the floor as well as the provider case management. Even our service areas to ensure that we don't have delays. We have heard that, progression doesn't stop. On the weekends. So we have, we really wanted to fine tune their work and their workflow before we move to a seven day a week model. We will move to that at the end of this month with our next care compass go live. So we will have care progression leaders in house seven days a week. And they will also have expanded hours. They'll be moving to a seven day to five p. m. Work day and we still will have an evening care progression leader in house as well. Thank you, Sam. I think you described them really well, but I do think there's still a little bit of confusion on their role because they are on the units. But we're saying that their role is a hundred percent concentrating on the progression of each patient on that unit. They start their day with leading our care progression rounds, but then They seemingly to the rest of the staff, they disappear. So could you maybe explain what they are doing in the background to reduce those bottlenecks and take care of our efficiency? Who do the CPLs coordinate with on the unit? Are there other areas that are involved besides just the unit? Sure. So after our care progression rounds they work in software called CareAdvance, and they're really, they review those charts, fine tune those charts and make sure that, things are progressing as expected. When things are not progressing that is what is considered a barrier to progression. We track barriers, log barriers, and then they actively work on solving those barriers, whether that be with another department or with nursing and then a barrier that can't be solved on the unit level is then escalated and they also attend daily escalation rounds at 1245. And that's where they meet with senior leaders to discuss any trends, any issues that they can't solve on the unit level and they would like assistance with. So what is one of the biggest goals for our care progression leaders? Yeah, so the goal is to keep them out of clinical care as much as possible and really be that center, centralized communication point. And so that does involve directing care. I don't want to say bossing you around, but just ensuring following up, giving clear direction of, we really need to get this walking pull socks by this time, if possible, to be able to have the earliest possible discharge. Were you able to complete that? Or can I help in some way? They also follow up with the hub. They act as an extension of the hub. They're that center contact point for bed management and closely collaborate about any discharge delays, really trying to facilitate those ambulance moves and early identification of those patients. They also, are collaborating with those departments saying, is there any way we can get this test done today instead of tomorrow? And really challenging cultural norms we have here at Tanner and that can be uncomfortable. I think a lot, there's a misconception that this is an easy job or a cush job. I think now if you ask them, they will tell you they, they definitely have had to have some uncomfortable conversations. It is a role that is, has a high potential for conflict. So a different kind of challenge than maybe traditional bedside nursing. Really working to change. That's just the way we've always done it. They're asking, essentially, the whys. Christy, we're going to go ahead and switch. things just a little bit. And let's go ahead and talk about the hub and bed management. Can you help explain another one of our inefficiencies or bottlenecks, which is moving our patients efficiently after a discharge or what happens once that patient is discharged and we don't seem to be getting the patients out of the system like we want to. We're here for the patients, and we have to do what's best for the patient. So ultimately, if they are ready and medically ready for discharge, we need to get them out as soon as possible. Doing so helps not only get that patient out to prevent any, future things happening with that patient, but to also move through our throughput and to be able to offset our ER. And the influx of patients that we might have down there or the patients that we are seeing down there. I know a lot of times people are wanting to know, why do they get pulled to the ER overflow so often? And that's part of it, if we can get those patients and transition them from the overflow to the right room the first time and to get those patients moved as quickly as possible, then we're offsetting the ER and we don't have to pull extra staff down there to help that influx of patients. Additionally as far as charting, you know we hear that a lot. I've got to go back and chart. I can't take this patient out yet, or but we have to remember there is a way just because the patient is taken out of the system. You can always get back in there very easily to chart. Most of the ANMs should know how to do this if you're unsure. But you can always go back in there and chart later. I don't think there should ever be a reason that we are delaying care or delaying getting a patient out of here because you need to go and chart. Because essentially, again, at the end of the day, We need to do what's best for the patient and getting a patient out of here that is medically cleared is most important. And then also getting that patient that is in the ER and needs that inpatient care to a room that's also most important. We need to make sure we're taking care of our patients. Christy, you made a really good point. Because we are trying really hard to ensure that we are placing the right patient in the right place at the right time. Part of our Care Compass initiative was to make sure that we had bed availability for the right patient. So we had that continuum of care throughout their stay. And we weren't moving those patients around to different either rooms or different floors during the time that they were here. Before we began this journey, we were just placing a patient wherever we did have a bed. And that made it very difficult when we had either a surgical patient or a cath patient because we would have to move patients around, which causes delays. One West was a great example of that when we would have anywhere between five to 10 medical patients on one west and bed management spent their whole day trying to move these patients so we could get our surgical patients where our physicians wanted them on one West. This also caused delays with. other patients either in the emergency department or with the patients that we had to move because now they had to have new doctors and that caused them to have additional delays because now that new doctor had to make sure they understood what that patient had and what their care really was. This also caused additional work for EBS, bed management. The nurses just having to get extra, another patient the physicians, the nurses, yeah, absolutely. We've seen a huge change. In the last probably year and a half, really focusing on identifying what types of patients go to which units and really being intentional about making sure that our patients go to the right bed the first time. Part of our staff and bed management, their goals their unit department goals include tracking same level of care transfers. And we've been able to reduce that significantly. Even in spite of the surge Our baseline, we were moving about 20 percent of our patients just unit to unit for same level of care transfers throughout the day. I think when I first came, our, we would spend all day just trying to make surgery beds on one West. And we've been able to reduce that down to less than 5 percent despite our surge. This is incredible guys. Because I think we are learning so much on what our CPLs and our bed management really do every single day. But one last question that I want to clarify while I know that our emergency departments, a part of it anyways, is used for, Patients that are really inpatients that we can't normally get on one of our units, especially during our busy time. And we call it our overflow unit. But technically, when our census starts to go down and we don't have as many of those patients, will we ever close that unit even if we have beds upstairs? Our current focus for that area in Carrollton is to transition it to what we call a CDU. And I think that term has been floating around and everyone's been like, what's a CDU, where's the CDU? So that stands for clinical decision unit. And our goal is to cohort our observation patients our observation patients are patients that stay is anticipated to be 24 hours or less. The goal is that they need more testing or monitoring in a hospital setting to decide if they need to be admitted as an inpatient or if they can be safely discharged home. Literature shows that when you cohort those patients and train staff to really focus on their status and prioritize their treatment that they tend to have better outcomes. their length of stay is much shorter and that creates additional capacity on the floors. When you have observation patients spread out throughout your traditional units, their stay tends to get to two to three days instead of that 24 hours. So we are working very closely with our physician partners and with case management to develop guidelines for this area as well as treatment protocols and have also created a observation committee with multiple disciplinary teams to help us as a system improve the treatment of these patients. So to answer your question, no, we won't ever completely close that area until additional capacity is created at both facilities. We're really focusing on honing in on the CDU and making this. Work in Carrollton. And then we will begin to focus on making our CDU work on our first floor traditionally known as the observation overflow in Vica. Thank you so much, ladies. It has been a privilege to have you on nursing together, and I have really enjoyed learning. about what you guys do on a day by day basis and what you two encompass within your areas. I know that there's so much more that we can talk about, so I do hope that you come on again so we can talk more about your areas and what you do. Thank you for having us. Thank you. Yes, thank you for having us. I look forward to coming back. Yes. And I would like to say that, Chrissy and I are always happy to hear from staff of any concerns, or if you just have a question of, Hey, why do we do this? We're happy to answer those. We can be reached, we do our best to round out in the areas, but we can also be reached on our office numbers or by email. So feel free to reach out. Absolutely. I agree. Thank you for tuning in to nursing together. If you found this episode helpful. Please share it with your fellow nurses and healthcare professionals. Until next time, take care of yourself and take care of each other.