Everyone at the University of Chicago Medicine brings unique skills and perspectives to treating patients and their families, and the culture of interprofessional collaboration allows clinicians and staff to support and empower one another as they work together to deliver high-quality care and innovative health solutions.
Several years ago, UChicago Medicine adopted the E3 Leadership model – a customized management system based on Lean Management principles that is helping transform all our employees into independent problem solvers. Under E3 leadership, nurses, physicians and staff Engage in improvement efforts, Evolve to meet the needs of patients and team members, and Excel in implementing their knowledge to ensure that UChicago Medicine remains at the forefront.
Transforming Patient Transportation
In spring, an interdisciplinary group gathered for a week-long IGNITE Kaizen workshop to brainstorm ways to reduce delays and improve efficiencies in patient transportation. Kaizen, which means continuous improvement, is a strategic part of our E3 Leadership model that brings together employees from across the organization to study and solve operational problems. Last year, UChicago Medicine held 74 Kaizen events and more than 180 nurses participated in these problem-solving sessions.
“Improvement relies on diversity of perspectives—it’s amazing what comes out when multiple disciplines are working together,” said Vineet Arora, MD, director of GME Clinical Learning Environment Innovation and IGNITE Kaizen Transportation team member.
Efficiency and teamwork in transportation have a tremendous impact on patients’ well-being. Transportation delays occur at every organization, but the UChicago Medicine team worked together—across units and professions—to develop processes to reduce any potential gaps in patient care or safety that could result from transportation delays.
The group developed a tool for training, managing expectations, building teamwork and highlighting improvement opportunities.
Surveying work areas, the workgroup identified how important each minute of delay in a patient’s arrival time can impact care and patient safety.
Solutions proposed by the team included:
- Detailed decision matrices to prioritize solutions for current and future transportation alerts to clinicians
- Future-state process improvements for handoffs, transportation notifications and education around mode of transportation for adult inpatient care
- Future-state process improvements for nurse notification of transportation requests and communication of transport changes or delays
- Step-by-step Standard Work and Leader Standard Work for adult inpatient, ancillary, procedural and operating room units
Nurses played a key role in the Kaizen process that improved our operations and teamwork, leading to lower transportation times and safer handoffs. This diverse team demonstrated a commitment to working together to find innovative solutions to practical problems.
Closing the Stroke Education Gap for Nurses in Argentina
Fernando Goldenberg, MD, director of neuroscience critical care and co-director of the Comprehensive Stroke Center, has provided online courses in stroke pathophysiology, prevention and management to hundreds of physicians since 2015.
When he was looking for a partner to help him expand the project to nurses in Argentina, he looked no further than Claudia S. Calvillo, BSN, RN, CCRN, with whom he had many conversations about improvements they both wanted to make in stroke care.
“Dr. Goldenberg first reached out to me because we are both Spanish speakers and he was looking for a nurse who could offer perspective and help design a program to enhance skills for nurses providing stroke patients care in Argentina,” said Calvillo.
To support Goldenberg and Calvillo’s initiative to close the educational gap around stroke care among nurses in Argentina, UChicago Medicine provided a $10,000 grant. UChicago Medicine further supported them by sending them to present their findings at the 2018 International Stroke Conference.
Through 32 interviews with Argentinean nurses, nurse managers, nurse administrators and government officials, Calvillo and Goldenberg concluded that there were too few opportunities for nurses to continue education without pursuing a formal degree. In collaboration with a nurse in Argentina and Goldenberg, Calvillo is developing 22 online modules that cover various stroke-related topics and skills that nurses need to know to provide comprehensive stroke care.
Nursing plays an important role in every part of UChicago Medicine’s tripartite mission of research, treatment and education. Furthermore, the sharing of knowledge to help as many patients as possible is one of the hallmarks of a Magnet organization.
“It meant a lot to me that Dr. Goldberg provided me support and resources that I needed, and that he really trusted me and my experience to drive the curriculum of the education program,” said Calvillo.
Enhancing Trauma Care
A year before UChicago Medicine’s trauma center opened, a trauma team of nurses, surgeons, anesthesiologists and staff began developing the Room After Trauma (RAfT) policy to ensure there would always be an operating room open and ready for an incoming trauma.
They developed a comprehensive call system, utilizing a yellow trauma phone in the emergency room and a script for doctors to use with nurses that enabled the trauma team to classify and communicate a patients’ care needs quickly to ensure smooth and efficient patient handoffs and operating room preparations. Operating rooms can be prepared in as quickly as four minutes.
As the team is setting up the OR, charge nurses are identifying the next RAfT room and start to prepare it for the next trauma case.
The perioperative leadership team worked side-by-side with the trauma team and created a trauma dashboard through which they can monitor, find opportunities to further streamline trauma operations and identify what additional resources or support the trauma team may need to improve and grow trauma services.
“It’s truly a team effort. We needed everything to be standardized because when a trauma comes, speed is so important. You don’t have time to think. You just act. The exceptional teamwork and dedication of our nurses, physicians and staff has enabled us to operate smoothly and efficiently in a very busy environment,” said Renee Pucik-Maisura, BSN, RN, director of Perioperative and Procedural Clinical Operations.
Ensuring Seamless Transitions in Women’s Care
Magnesium sulfate is a critical medication used to help stop preterm labor in pregnant mothers. The extra time the baby spends in the womb, even if it is just a few days, can be critical for the health and safety of both mom and baby. Providers across the country struggled with the national magnesium sulfate shortage in May, but Women’s Care nurses responded swiftly, collaborating with pharmacy to lead the necessary transition to premixed, lower dose magnesium sulfate bags to ensure the safety of every mom and baby who was receiving care during this transition.
Within the span of one week, nurses, physicians, pharmacy and the education team devised and implemented the plan to smoothly transition to the new magnesium sulfate bags, ensuring the correct medication dosage was given to every patient.
“We had an incredibly tight timeline to make this change, and changes can be especially difficult when they need to occur over a weekend,” said Jennie Sierra, MSN, MBA, RN, director of the Women’s Care Center, who meticulously and thoughtfully guided the team through this transition. “Since our new dose was less concentrated, we needed to take into account that patients were going to get twice the volume of liquid to get the correct dose. It took multiple disciplines to make this a smooth process, and I’m proud of how cohesively all our nurses, physicians and staff worked together to make sure all our moms and babies received safe, quality care.”
The planning committee communicated with staff, led education for nurses and physicians, and made the necessary changes in Epic, UChicago Medicine’s electronic health records system, to enable physicians to order the correct dose and swiftly communicated with staff.
Continuing Preventative Care for Patients After Bariatric Surgery
Patients who receive bariatric surgery must adhere to a post-operative diet and routine to prevent common issues that can compromise a patient’s health, such as dehydration, bed sores, blood clotting and tenderness around the surgical site.
UChicago Medicine nurses and physicians noticed patients coming to the clinic with these issues, and established a process to proactively check in with patients to reiterate and reinforce post-operative home care to prevent these issues.
Nurses call patients within three days of discharge to ask them how they are feeling, the nature of any pain or discomfort they are experiencing, their level of physical activity, the number of meals and amount of fluids they are getting per day and the number of times per day they are taking their medication.
UChicago Medicine’s Alisha Wilson, BSN, RN, nurse associate, worked with Vivek Prachand, MD, executive medical director for procedural quality and safety, and Mustafa Hussain, MD, director of the center for the surgical treatment of obesity, to develop a post-operative script. The talking points guide conversations and ensure that the nurses making these calls receive all the necessary information to determine whether patients require additional care and nutrition education or need to move up the date of their next post-operative appointment.
“Over the past year, we have seen a decrease in the number of bariatric post-operative patient admissions and ER visits. If patients have trouble spots it’s very easy during these proactive calls to discern that and get them in early for a post-operative visit,” Wilson said.
The Stroke Inside – A Story From the Other Side of a Stroke
Stroke is the leading preventable cause of disability and the number five cause of death in the U.S. To further awareness and education about stroke response to prevent disability, UChicago Medicine ER and Neurology ICU nurses, physicians, speech pathologists, occupational therapists, physical therapists and staff worked together under the leadership of Jorge Ortiz Garcia, MD, NeuroCritical Care Fellow, and Claudia Calvillo, BSN, RN, to develop a short film, which was featured at the American Academy of Neurology sponsored 2018 Neuro Film Festival.
The video was filmed from the patient’s point of view, giving the audience’s perspective on the stroke experience and effective stroke response from loved ones and hospital clinicians and staff. UChicago Medicine clinicians and staff featured in the video provide compassionate care to the stroke survivor, clearly explaining and demonstrating the care a patient receives after they experience a stroke, providing education and take-home resources on stroke care
“The stroke care team showed how strong collaboration across departments and care teams is important to provide safe, quality care that gets patients back to their daily lives,” Deborah Reindl, BSN, RN, patient care manager for 8 North and 8 South. “I am proud of our stroke team, who demonstrated our excellence and dedication to compassionate patient care.”
Collaborating to Reduce Length of Stay in Orthopedics
For the last three years, advanced practice nurses, registered nurses, physicians, physical therapists, care coordinators and social workers on the orthopedics team have worked collaboratively to improve the patient experience in the hospital and enable patients to return home sooner.
From pre-admission work ups to discharge, UChicago Medicine clinicians and staff are by the patient’s side providing quality care. Nurses round on patients every morning to review their status and work with other members of the care team to ensure that patients receive any additional support or care they need.
Making advances to improve the patient experience and reduce length of stay requires trust, respect and streamlined coordination among colleagues. Staff nurses, unit leadership, social work, physical therapy and advanced practice nurses have worked together on this sustained effort to allow patients to return home more quickly.
This collaborative effort has resulted in a decrease in hospital length of stay from an average of 2.75 to 2.25 days, increasing home discharge from 45% to 65%.
“We adjusted our staffing levels based on nursing input for our high volume admission and discharge days, and I do think that had a lot to do with the improvements in length of stay,” said Sandra Armstrong, DNP, MSN, BSN, RN, patient care manager for 8 West. “I was impressed with how quickly we were able to turn this initiative into an everyday workflow of our unit. Teamwork and collegiality are essential for us to constantly improve patient care, and I’m proud that we foster a culture that makes it possible for people across different disciples to seamlessly work together.”