Interprofessional Collaborative Approaches to Reduce Risk, Decrease Financial Loss, and Improve Patient Care Outcomes in Acute Care and Skilled Nursing Facilities

Background

The recent economic crisis has increased pressure on hospitals, subacute, and long-term care facilities to reduce operating expenditure such as labor, supply, capital, and litigation costs. Additionally, the shift from fee-for-service to outcome-based reimbursement models increases a facility's expectation to perform in order to maintain revenue streams and continued operations. Current efforts to improve quality care while maintaining cost efficiencies have been taken on throughout the wide spectrum of care delivery: from administrative measures such as risk sharing partnerships between hospitals and third party payers, to process improvement strategies such as integrated electronic health record systems, to direct care approaches such as interprofessional team-based models. When teams perform risk reduction and quality improvement activities patient care improves and financial loss, in part, is mitigated. This project will focus creating a care model based on workflow logistics, communication tactics, and customer service strategies at the unit level to help reduce risk and cost of care, and improve care performance and patient outcomes.

Problem

Common facility- and hospital-acquired conditions (HACs) are largely preventable if evidenced-based interventions are correctly implemented. However, studies on how nurses spend time indicate that interruptions or assignment overload often lead to medication or protocol error, and incompletion of preventative interventions. These deviations from the care plan can result in harm to the patient, which may lead to increased hospital stays, auxiliary administrative and care services, loss of opportunity to fill beds with new patients, denial of reimbursement, increased hospital and professional liability insurance, litigation costs and judgments, damaged reputation, loss of patients to competition, staff discipline, and patient dissatisfaction. Unfavorable care outcomes may not stem from staff “not knowing what to do.” Abundant research on HACs have resulted in proven evidence-based care strategies, and facilities have often integrated these interventions into policy, education, care, and documentation requirements. Nevertheless, staff may be unable to fully complete tasks known to prevent HACs due to heavy assignment loads and other competing demands. This problem poses the question: how can managers structure workflow operations that promotes efficiency and a culture of care, that also increases follow through on evidenced-based preventative interventions?

Objective

This project will attempt to offer interprofessional collaborative workflow logistics, communication tactics, and customer service strategies in a nursing care delivery model. The model will increase communication between nurses and their unit assistive personnel, assigns specific accountability to staff to perform preventative tasks, reduces risk of HACs,  increases work performance, and ultimately increases staff and patient satisfaction.

Method

Via secondary analysis, the project identifies prevalent unintentional patient outcomes that affect facility/professional liability, can increase variant care costs, and negatively affect  the patient experience.  An examination of medical liability claims, current and emerging risk management reports, care delivery models, and evidenced-based care interventions are used to construct interprofessional workflow solutions that target these unintentional outcomes. The project will design a care delivery model based on the evidence-based interventions and incorporating workflow logistics, communication tactics, and customer service strategies. The project will also attempt to propose a plan to test the model. Testing the model would involve measuring risk-reduction, cost efficiencies and indicators of improved care; quantitative and qualitative measures may include number of HAC-specific tasks (e.g. repositioning to prevent pressure ulcers, catheter care to prevent UTIs) completed in a given time frame, number of HACs in a given time period with implementation of the model, patient satisfaction survey results during implementation of the model, staff feelings on the model, etc.  

Results, Findings and Conclusions

As part of a student nurse's senior honors project, the project is in the model development stage as of August 1, 2014. Upon completion of the project,  results, findings and conclusions will be presented at an honors colloquium in spring of 2015 and can be found in the Rhode Island College School of Nursing archives.