Holding gain becomes more than half the battle
Prevent slippage by communicating, monitoring
Holding the gains they made in a recent open-heart surgery initiative is very important to the team at Morton Plant Hospital in Clearwater, FL. (See cover story about the initiative.)
Reducing cycle time, standardizing equipment, and changing staffing patterns helped the most toward cost lowering, but those factors can easily take the slippery slope route once an initiative is completed. To avoid that, the team has been constantly monitoring the changes that they implemented.
"Since our project ended, we’ve seen a little backsliding," says Jennifer Lain, BSN, cardiac surgical case manager at Morton Plant.
They are trying to tackle the problems on their own now, using tools they learned through the Institute for Healthcare Improvement collaborative — how to run a cycle, how to measure, the importance of leadership, the importance of timely feedback, and display of data.
"Some staff members have gone back to the old ways of doing things," says Cheryl Young, RN, director of surgical services, "and communication is beginning to slip back to the way it was before it was improved."
When you’re paying attention to a process, gains are easier to hold onto, she explains. Improvement projects start with the physicians, and those physicians and others on the staff have to make sure to continue to communicate after projects come to an end.
Young says the cardiac team is starting now to take another look at cycle time in the OR. They have added some techniques, so the open-heart surgical team leader is again beginning to collect data on different sections of a case so they can compare their current cases. Away from the collaborative, "we’ll establish some new benchmarks for ourselves now," she says.
The team stays in contact with representatives from the other 41 institutions who took part in the collaborative with them through a cardiac surgery listserv. "We speak to one another and post questions and answers," says Lain.
Among some future projects, she says, are:
• To reduce inhospital days for patients who develop post-op atrial fibrillation in DRGs 107 and 106 (coronary bypass with cardiac catheterization).
• To continue to monitor and evaluate OR disposables.
• To further refine parallel processes in the OR.
• To develop a dedicated pre- and post-op teaching program by nursing staff.
• To assess functional outcomes up to one year post-op.
• To blur the distinction between the cardiac surgical ICU and the progressive care unit into a variable care unit concept.
• To expand the guided imagery program to include interventional cardiology patients.
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