Getting physician buy-in takes lots of preparation
Micromanaging patients eased transition
You and your ICU nurses have worked for years to develop the trust of your physicians. Suddenly it’s time for a change, and you know the reaction from the doctors before starting.That was the dilemma facing the Critical Care Management Team at Baptist Hospital in Miami when it wanted to improve efficiency and lower costs by moving some patients to a less intensive step down unit. "Getting physician buy-in was the most difficult part of the process," says Diane Bolton, RN, director of critical care and acute care services at the hospital.
Here are some tips she offers for winning physician support:
• Do your homework.
Critical Care Center (CC) medical director Andrew Egol, DO, and Beth Willmitch, RN, coordinator of the hospital’s APACHE clinical information system, took the data to every physician group, presenting the plan, making sure everyone understood it, and enlisting medical staff support. "Intellectually everyone sat there and nodded their heads, but when we said "Now it’s time to make the change,’ their reactions were, Well, okay, but you’re not going to move my patients,’" says Bolton.
• Tap physician expertise.
One major problem, says Bolton, was that the physicians were familiar with the CC staff and procedures and didn’t have that level of familiarity and confidence in the step down units. "We first had to convince the physicians that, for example, in the case of carotid endarterectomy patients, we could provide the level of expertise for the staff in the step down unit that was comparable to the CC staff," she says. "We prepared a curriculum for educating the step down staff, presented it to the physicians, and invited them to participate in teaching.
"We got good reaction from our physicians. It was like they thought, If I teach them they’re going to be taught right.’" That gave the doctors an opportunity to become more familiar with the step down staff, which boosted their confidence in those nurses, Bolton says.
• Start with TLC.
When the new system was inaugerated, "We pretty much had to micromanage the patients who were placed in that alternative setting to asssure that everything ran smoothly," says Bolton. Every day members of the management team checked on step down patients and their physicians about any concerns or problems. "We really had to closely follow those patients because it took time for the physicians to develop trust and confidence in the setting and the staff."
In the end, says Bolton, the physicians came to accept the new system. "Change became the norm. The doctors almost seemed to have forgotten that these patients used to routinely go to the Critical Care Center," she says.
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