In a packed warehouse dozens of staff, physicians, administrative leaders and patient advisors explained their blueprint for exceptional care. Creating that vision is something patient advisor, Mary Lee Simpson, won’t soon forget.

Interprofessional Communication and Rounding team members

Interprofessional Communication and Rounding team members demonstrate their vision.

“At the very beginning we were asked what we expect and fear. My expectation was that the patient and family voice be heard and my fear was that it wasn’t going to be heard,” explained Simpson to the crowd. “Every time we offered an opinion, I think all of us felt that our experience was validated. That we were heard and our concerns were heard and going forward we all feel we are going to be a more important part of our care or our child’s care.”

Simpson joined 60 staff, physicians and patient advisors who spent five days diving deep into data and examining decades-old processes all to develop a new vision of care for the future. The goal is to improve the patient and family experience to ensure care providers spend more time for direct care, assessment and teaching. The work is supporting one of the Region’s priorities for this year – Children’s Hospital of Saskatchewan Care Delivery Review and Design.

Team members include staff and physicians from Clinical Teaching Unit 6200 and Acute Care Pediatrics at Royal University Hospital, along with emergency, and included representation from occupational therapy, physiotherapy, social work, speech language pathology, respiratory therapy, pharmacy, diagnostic imaging, lab, client patient access services (CPAS), spiritual care, eHealth, supply chain and unions.

The participants were guided by five patient and family centered care non-negotiables including shared decision making, knowing the patient and family, interprofessional collaboration, continuity of care seven days a week, and a supported learning environment.

A New Nursing Model

“Acute care pediatrics and 6200 both had very different nursing models. Both had lots of strengths and what we did as a group was pull apart all those strengths that we saw in the models and apply them to a new model,” explained Tammy Lucas, manager of acute care pediatrics to the crowd. “We looked at what roles and what functions we needed staff to do and what expertise they would bring.”

The new patient-centred nursing model includes a clinical expert who is there 24/7 as an expert resource for unit staff, and who will assign specific team members to different pods within the unit. Under the clinical expert, a unit leader who is a registered nurse (RN) will work with his/her team to provide day to day care, oversee progression of care and make sure rounding is being done. The team may include registered nurses, licensed practical nurses or continuing care assistants. Assignments will focus on putting the right staff with the right patient.

“This is really changing how we work,” explained Lucas. “With the same number of staff and new model, we are putting the staff with patients depending on patient acuity, staff skill set and experience and (we are) utilizing everyone’s scope.”

The team also envisioned a unit liaison who will work through capacity and flow including triaging admission. This person will work closely with the clinical expert. Finally, there will be clinical nurse educators who support the unit’s managers and all the staff, along with unit assists and other support continue to be an integral part of the unit.

Plan of Care and Logistics

Some key assumptions with this new vision include the role an electronic medical health record will play in this new future. Team members outlined how important it will be in the transfer of information and to have one patient document.

“This includes some common patient information, progress notes and activation goals,” explained team member Barrett Blue. … All the information is being updated in real time. It’s available at the patient’s bedside and being updated on their smart board, for example.”

Sample tool developed by the team.

An example of the tool developed by the team focused on the information that would be available to patients and families. This tool would work like a smart board that would have key information about the unit and where a family could pull up their loved one’s care plan for the day.

The team’s vision is the single plan of care that would remove duplication of a lot of the questions patients are repeatedly asked during their stay.

“If that information is in real time and being fed to the same document, we don’t have to repeat some initial past medical history, for example,” explained Blue. “And all the information customizable. … How do I, as a pharmacist, want that (patient’s) profile to show up when I have my point of care device and when I am talking with patient and family?”

With a new nursing model and key logistics in place for plan of care, other team members brought these elements into another new care processes.

Admission

A three-person assessment team will go down to emergency to meet with a patient requiring admission to the ward. The team could be made up of physician, RN and pharmacist who will complete an interprofessional assessment using point of care devices with the hope of decreasing the duplication of questions asked of patients and establishing the single an interprofessional plan of care

As the assessment is completed with patient and family input, the plan for the next 24 hours to deal with issues is developed, referrals are being initiated, orders are processed and a discussion about estimated length of stay for patient is discussed at the same time.

Orientation to ward and 24/7 progress of your care

One of the assessment team members will follow the patient up to the unit. A patient and family will receive an orientation of to their ward and the information available to them, including their plan of care for the day and their own daily goals. This team envisioned a device that looks like a smart board that would have key information about the unit and where a family could pull up their loved one’s care plan for the day.

New handover processes

Another team worked through the handover process. A handover is a formal transfer of care between two health care professionals. They standardized unit to unit transfer (i.e. emergency to ward) and shift to shift report to focus on two key care transition points which contribute significantly to continuity of and safe patient care. Standardized tools were developed for both. This will be done at the patient’s bedside and information would be used to update whiteboards/smart TV in the patient’s room. The new handover processes will incorporate three key principles:

  • any handover patients and families will be involved in whatever level they are comfortable in a language they can understand.
  • any information in the care plan is current and reliable.
  • standard method of relaying information is through scripted tools.

Beyond handovers, another team looked at how the interprofessionals work together on the unit. New words are making way to reflect the function of the vision.

Example of the visual management board

An example of the visual management board that could be used to show the “patient status at a glance” by the interprofessional team during morning check-in.

Interprofessional Communication and Rounding

This team envisioned patients located in a geographic location that would be served by an interprofessional team comprised of the same staff as much as possible; where the team would work together rather than just coming together sporadically. Patient care would be coordinated and seamless, provided 7 days a week.

The interprofessional team would have a morning check-in to establish the responsibilities for the day. Members will use a visual management board to show the patient status at a glance. After members get an overview and disband to do their individual treatments and assessments, they get back together for team rounds, seeing all patients and families as a team. Patients and families could indicate whether or not they want to see the full team or only certain members.

There, the team will discuss and document daily goals and progress, again using the smart board or white board to update and review before they leave.

Coordination of care and progression of care

“This community of practice will be culturally appropriate and patient and family centred 24 hours a day – seven days a week. This means they will have the same access to care and same standard of care as well as access to tests seven days a week,” explained Dr. Krista Baerg with Acute Care Pediatrics. “This team is interprofessional and will be visible, consistent, accessible and tied to patient throughout their stay. A plan for the day and a plan for the stay are visible at a glance.”

It’s this concept, among many others developed during the week, that had patient advisor Erin Burr excited by Friday afternoon. She told the crowd that five years ago she had no choice but to be thrown into life in our health care system when her son was born with a chronic medical condition.

“Seven days a week is huge for me,” explained Burr. “If you are in the hospital and its Friday and its 3 p.m., you know you are sitting there all weekend. You have to wait to Monday before speaking to anybody. Now I know that Saturday and Sunday is going to be just like every other day which is so awesome. That is the part I am most excited about. I can’t wait to see it in action.”

The actions that were recommended by the teams didn’t come easy.

“Thank-you to all of the staff and physicians who participated,” says Petrina McGrath, Saskatoon Health Region’s vice-president of people, practise and quality and sponsor of the week-long design event. “It takes courage to come, participate and be engaged. The discussions, and there were some challenging discussions, are really important. You came together as an interprofessional team and put things on table to find new processes that worked for patients and families.”

But McGrath knows the next phase of hard work is now about to begin.

“This is a beginning blueprint. We asked people to think of the future. We asked them to create exceptional interprofessional processes,” says McGrath. “Now, we are really working through, ‘Okay, what are the first steps? What are the key things we can do coming out of this right away?’ There is a lot of detail in what we designed that we still need to work through.”

The care delivery review and design team is already reviewing the blueprint designed by the teams and will be determining a work plan for how to bring this vision to reality. More information about this plan will be available in the coming weeks.

More information will be available on the Children’s Hospital of Saskatchewan website at http://www.saskatoonhealthregion.ca/chs under “Transforming Your Care – Care Delivery Review and Design”