By David Robinson
At 9 a.m. on a bright January morning, a large team of UAMS health care professionals huddled briefly outside a patient’s room on the hospital’s eighth floor.
A quick review of the case – a man with diabetes whose leg was amputated – was led by Susan Beland, M.D., who was joined by two medical residents and a medical student. Around them, with pens and clipboards in hand, were the bedside nurse, discharge nurse, clinical nurse specialist, case manager, pharmacist and social worker. When the group filed into the patient’s sunlit room, Beland went to his bedside to learn how he was doing. His wife sat in a recliner near the bed.
The meeting lasted only a few minutes and might have seemed routine; however this was anything but standard operating procedure. At UAMS, it was history in the making – having all of the patient’s caregivers present at the same time, with him and his wife invited to discuss any of his health care issues. The goal of the meeting – known as interdisciplinary rounding – was to ensure the best possible chance for a good outcome as his recovery continued in the hospital and then at home.
“Everyone has to be on the same page,” said Rowena Garcia, R.N., M.B.A., clinical services manager on the eighth floor where interdisciplinary rounding is being piloted. “If there are questions or if there’s confusion about anything related to that patient’s care, it can be dealt with right there.”
Patient- and Family-Centered Care
Interdisciplinary rounding is part of a larger effort at UAMS, and a growing movement nationally, to provide patient- and family-centered care. The new approach is summed up in the mantra borrowed by UAMS leaders: Nothing about me, without me. It emphasizes four concepts:
- Dignity and respect for the patient – listening to and honoring the patient and family perspectives and choices
- Information sharing – communicating and sharing complete information with patients and families in ways that are affirming and useful
- Participation – patients and families are encouraged and supported in participating in care and decision making
- Collaboration – patients, families, health care practitioners and health care leaders collaborate in policy and program development, implementation and evaluation
Shock outlined how it will not only improve care and patient satisfaction, but will lead to cost savings by improving patient outcomes. He noted that about 10 percent of the country’s population consumes 64 percent of health care expenditures. Most of this cost is linked to patients with chronic conditions such as coronary artery disease, congestive heart failure and diabetes. Reducing avoidable complications and hospital readmissions related to chronic diseases would significantly reduce costs.
UAMS leaders also are motivated by the knowledge that health care spending nationally is out of control. Over the last 30 years, health care spending in the United States has been 2.1 percent more per year than the growth in gross domestic product.
“National health care reform notwithstanding, we can institute our own reforms that will allow us to actually turn back money to the federal government and improve our quality of care,” Shock said. “The bottom line is we want to take better care of patients, we want to bring down costs, and we don’t want to bankrupt the country.”
On the Bandwagon
Not long after Shock presented his findings to campus leaders, Chancellor Dan Rahn, M.D., with the support of other key UAMS leaders, determined it was time for UAMS to get on the bandwagon, and he asked Shock to coordinate the effort.
An executive advisory committee and a steering committee of hospital and College of Medicine leaders were assembled. Barbie Brunner, formerly director of clinical programs education at UAMS, was named director of patient- and family-centered care.
In addition to interdisciplinary rounding, Brunner said, the entire hospital in 2011 moved nurse shift changes to the patient’s bedside. The outgoing nurse meets the incoming nurse at the patient bedside to give a detailed report of the shift. This bedside report involves the patient and family to help with a plan of care and goal setting as they care for the patient and prepare for discharge.
“It’s another example of improving communication, putting people in a better position to solve problems, dispelling patient anxiety, and ensuring quality and safety,” Brunner said.
Already patient satisfaction scores are trending upward. Those scores are important because increasingly they are tied to hospitals’ federal Medicare reimbursement rates. In 2013, Medicare will withhold 1 percent of hospital reimbursements until hospitals can show sufficient patient satisfaction scores.
Also, UAMS Medical Center boards and committees overseeing hospital and outpatient functions soon will include staff, patients and their families.
“The goal is to have former patients involved in many of the aspects of our operational structure and of the decision making that takes place on our campus,” Brunner said.
“This is a journey,” Shock said. “It is going be a slow but sure evolution of change in the culture.”