Blue_Print

Four tips for redesigning care delivery

By Terry Hayes, RN MSN, CPNP, CNOR  /  21 Sep 2015

Hayes Headshot 2015 newFor years, there have been studies showing that clinicians are decreasing time spent with patients due to competing demands. Nurses say that out of a 12-hour shift, only two hours are spent on direct patient care, and doctors spend only 27.5 percent of their daily working time with their patients. As providers look toward value-based care, they’re quickly realizing that having clinicians spend only a fraction of their days on patient care will no longer cut it. Smart providers are looking for ways to not only redesign their hospitals, but also re-engineer workflow so clinicians can spend more time on direct patient care and improve the patient journey through the hospital.

Through my varied experiences as a healthcare and hospital construction consultant and as a registered nurse and nurse practitioner, I’ve found a few areas within hospitals ripe for redesign:

  • Make the best use of space. This sounds simple, but many hospitals today still have doors that swing the wrong way, making nurses double back to move patients through the hospital. By looking at which way the door swings—and the most common patient flows—providers can help nurses shave off valuable seconds and help patients move swiftly around the hospital. Hospitals should also look at creating flexible spaces that can serve more than one function. For example, some hospitals have created pre-op rooms that can later serve as a post-op space later in the day so that rooms aren’t vacant. Maternity units also provide an opportunity to make the best use of space; by turning patient rooms quickly into delivery rooms, hospitals can maximize space and improve workflow.
  • Put the nurse station in the center. As a nurse, I know how critical it is be close to the bedside. Between call buttons, alarms, new dosages and other urgent demands, it’s hard to be more than a few steps from the patient. Hospitals have already begun to find ways that bring the nurses’ station closer to the bedside, making it easier for nurses to respond quickly, without disrupting their workflow. Many units are now designed with nurse work areas located adjacent to the rooms rather than centralized. With the advent of portable units for electronic medical records and medication administration barcoding systems, the nurse can be connected to the patient, even when mobile.
  • Adjust staffing. One of the main issues I see with hospitals is that their staffing models often don’t reflect their needs. Oftentimes, simple staffing adjustments can help address patient demands when census is highest. Additionally, understanding workflow challenges can lead to solutions designed to facilitate timely discharge of patients. For example, one of the hospitals I worked with added one lab technician to their early morning shift, and by making that small change, labs processed results earlier, patients were cleared for discharge faster and the hospital drastically improved its throughput.
  • Automate notifications. Care team coordination is critical, particularly as we look to population health models that take into account patients across the full healthcare continuum. But in many cases, clinicians spend too much time sending non-urgent updates via email, phone or EMR message, such as a patient being discharged from the emergency department. New technologies are making it possible to automate these messages so that all relevant parties are kept in the loop, without requiring any extra staff time.

By redesigning a few areas within the hospital, providers can give nurses and other clinicians the ability to spend more time with patients and improve efficiency at the same time. How is your organization redesigning the way you deliver care to improve efficiencies and clinician workflow?

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