Providence begins its acute-care transformation

Portrait of Judith Tatman, RN, BSN, MS

Judith Tatman, RN, BSN, MS
Chief nursing officer, Oregon Region

May 15, 2013

Epic has brought vast changes to our clinical systems, and now the way we provide inpatient care is changing as well. Beginning this month Providence St. Vincent Medical Center will be the first Oregon hospital to adopt an interdisciplinary, team-based practice model that puts the patient’s care needs at the center of decision-making. The model supports all disciplines practicing to top of license and scope of practice.

The concept – designed by a team of clinicians and administrators – is collaborative, and many of its attributes were based on interviews with patients. Our goal is to provide safer and more effective patient care than can be delivered through our current discipline-based silos.

The new model will be rolled out in phases and refined as needed. It includes:

A single, interdisciplinary plan of care for every patient
Instead of multiple plans from various care providers, this design incorporates their notes and expertise into a single plan that is accessible to the entire care team. The plan is developed within 90 minutes of admission to the unit.

Interdisciplinary daily rounds
Using the patient’s care plan as a guide, the goal is to standardize the rounding process and improve communication between disciplines. Patients and families will participate in discussions and decisions. The make-up of the rounding team will depend on the patient’s specific condition and risk factors.

These real-time decisions are expected to reduce errors and redundancy, and also to streamline workflow by requiring fewer calls or texts to clarify questions and plans.

Discharge by appointment
By “preplanning” discharge, physicians and nurses – and most important, patients and families – all know when the patient is going home and can plan accordingly. Likewise, organized discharge helps our facilities better control workflows.

Greater pharmacy integration
By bringing pharmacy closer to the patient and care team, the pharmacist can help educate patients and provide oversight and expertise to the care teams. This not only improves patient satisfaction, as early testing found, it also may help reduce readmissions.
Improved planning before and after the hospital visit
Standardized preadmissions, patient education, collaboration with primary care providers, and coordination of post-discharge care and equipment will help ensure a seamless care continuum.
This month PSVMC introduces the first phases of this model, beginning with interdisciplinary daily rounding on the cardiology and orthopedic units.
Through this design process, we expect to increase patient safety, improve patient satisfaction and provide better measures of outcomes. We also hope to limit the daily chaos that clinical staff and providers experience in the acute-care setting. Eventually this model will be broadened to all eight Oregon hospitals and possibly across the Providence system.

As we prepare for an uncertain future in health care, we believe this work will better position Providence for the complex clinical and economic challenges of tomorrow. If you have any questions, please email me or project manager Janiece Zauner.