On any given day at BWH, the patient census can vary tremendously. One recent morning, 35 patients were in the Emergency Department and PACU waiting for beds, and the surge pod—a pod that opens when no beds are available—was already full.

“Because we have such variability in terms of our number of patients from day to day, we need to determine how to create space for patients when they need our care,” said Jackie Somerville, RN, PhD, chief nursing officer and senior vice president of Patient Care Services. “We need to smooth variability and become more efficient to improve the patient experience and ultimately reduce costs.”

Patient Progression

To achieve these goals, BWH launched a strategic initiative called “Patient Progression” this fall. Co-led by Somerville, Chief Medical Officer Stan Ashley, MD, and Chief Operating Officer Mairead Hickey, RN, PhD, the initiative takes a multi-pronged approach to solve the variability problem.

“How do we ensure that when patients are clinically ready to leave the hospital that we discharge them?” asked Somerville. “How do we ensure they are not, at that moment, waiting for discharge education, a prescription to be filled or any of the other things that add hours onto their length of stay?”

Patient Progression centers on ways to improve communication among the many multidisciplinary team members involved in a patient’s care, whether they are direct care providers or are involved with a patient’s stay in another way.

“We’re working with Admitting to get patients to beds, and with Transport and Environmental Services to make sure we can get patients to beds and turn rooms around in a timely fashion,” said Somerville.

A Team Effort

Members of a patient’s care team will be involved in brief huddles throughout the day to ensure everybody knows the patient’s plan of care and can achieve plan goals. “It’s a quick discussion of what’s going on with each patient every day—when the patient is going home, what the goals are that day, what tests or other things need to be scheduled,” said Ashley. “We also want to engage the patients and their families in these huddles so they understand the plan of care.”

Regionalization is another way to enhance communication by bringing team members physically together on the same unit or groups of units. This practice, which already rolled out successfully on the General Medical Service, ensures clinical teams and units are brought together around their patients and families so they are not spreading their time across multiple units, which can cause delays in discharge and inefficiency.

Other improvements include tracking software, a database that examines metrics and will help keep BWH on track to achieve the goals of Patient Progression.

“If we are successful in these practices, we could potentially decrease length of stay for each patient by about eight hours,” said Somerville. “When you add that up across 793 beds, it creates an additional 16 to 18 ‘functional beds’ for us.”

Multiple units have already kicked off the interdisciplinary huddles this week, with other units expected to begin in January. To learn more, visit BWHPikeNotes.org.