Background: A 24-bed general medicine unit at Emory University Hospital has a history of implementing innovative change. This unit developed Emory Healthcare’s model of patient centered, interprofessional collaborative practice (PC-IPCP), and is the original Accountable Care Unit. In spite of that, the unit experienced barriers to achieving patient safety and quality outcomes due to marked inefficiencies in the way assignments were made. Historically, assignments were made by utilizing acuity-related criteria and did not consider the unit geography, thus creating assignment patterns located on the opposite ends of the hallways that produced challenges for patient care, bedside shift report, and participation in multidisciplinary rounds. Nurses also felt their response times to patients’ calls were unnecessarily delayed. This was reflected in lower than desired patient satisfaction and higher fall rates. Nurses and patients were frustrated by the inefficiencies of direct communication and the care gaps that the chaotic assignments created.
Methods: The new assignment methodology considers unit geography; the AACN Synergy Model© principle of matching the skill of nurse to patient needs; nurse participation in daily interprofessional rounds; and a buddy system, to create a strong patient safety net. A schematic flip chart was designed by the Unit Director to guide charge nurses in selecting flexible assignment options which promoted timely planned and unplanned patient care activities. The unit level leadership team took a deliberative approach, piloting one zone assignment at a time, but due to the overwhelmingly positive responses from clinical nurses, the pilot phase was shortened and the model fully implemented within two weeks.
Summary: Within six months after implementing the model, falls decreased by 58%, incremental overtime decreased by 60%, patient call light rate dropped by 49%, and the average distance walked by clinical staff decreased by 1.2 miles per day and currently remains sustained. Nurses verbalized increased satisfaction with their ability to meet their patients’ quality and safety needs, and both providers and nurses described efficiencies gained in their daily collaborative practice rounds. Patient satisfaction scores remained above average. This project demonstrates application of patient-centered care, teamwork, collaboration, patient safety, and quality care.