As health reform moves forward, we will need to work with fewer resources and find innovative ways to streamline care. One such solution is what my group calls “Team Care”—medical personnel working together to optimize efficiency. As ED visits go up and the patient traffic increases without any increase in structural capacity, Team Care adds functional capacity by reducing overall time in the department.
For example, Team Care is cutting the throughput times for patients in our EDs. Recent studies have shown that crowded EDs are more than just a financial drain and risk management concern for hospital; they are actually bad for patients’ health. Waiting in an ED is like a layover in an airport. Nobody likes sitting around in airports waiting for departures that never seem to happen. In an ED, it’s even worse: the people who have to wait are anxious and in pain. For some patients, waiting for care can be life threatening. But even for patients who are not critically ill, long lines in the ED can lead to dissatisfaction. ED patients need to get checked in quickly, and then be either admitted to the hospital or released to go home as soon as possible. And Team Care helps this happen.
There is no single formula for implementing Team Care, as what works at one site may need to be tweaked for another. But the benefits of a team working more efficiently make this program a key strategic initiative for the future. One great example of a Team Care system took place at Mercy Hospital in Oregon, where Wade Fox, DO, and Sam Jones, RN, BSN, Director of Emergency Services, implemented a program that increased patient satisfaction and staff morale, and reduced Turn Around Time to Discharge by 20%. Instead of assigning one nurse to three or four patients and having techs serve 12-14 patients apiece, they now have two nurses and one tech for every eight patients, working as a team with the doctors and PAs. Instead of being tied down by specific patient assignments under the old system, any nurse or tech can help whichever patient is in need, and can assist any provider. Patients get to see their medical personnel in the room working together for them as a team. This raises patient satisfaction and improves communication among the medical staff. Fox says that his staff has been so energized that often times when he announces on their communication system what room he is going to, the staff has already anticipated this and is their already waiting for him.
In order for Team Care to be optimally engineered, program innovations can be implemented at each stage of a patient visit: the beginning, when the patient arrives for intake; the middle, when assessment occurs; and the end, when discharge takes place. For example, I see sites station a physician at the front as part of Team Rapid Medical Evaluation (RME)® in order to begin the assessment process in stage one. For the middle stage, we have established a buddy system where nurses are buddied up 8:2 instead of 4:1 to free up their entrepreneurial spirit as was done at Mercy. And to facilitate stage three, providers and nurses are meeting together with the patient at the end of the visit to deliver the discharge instructions. This prioritizes the discharge, ensures everyone hears the same message and facilitates the patient getting out of the ED sooner. I often see providers print out the discharge paperwork themselves and directly discharge patients. Within a week of these adjustments at Olympia Medical Center, the discharge times immediately improved. Just imagine if you saw airline pilots at the gate helping reduce red tape so customers could get on the plane quicker?
The theme behind Team Care is that communication is enhanced amongst all members of the team. The physician may be “the quarterback” overseeing the big picture, but members of the team are encouraged to share leadership. For example, when it happens that the nurse has important information about the patient that the provider may not, the physician welcomes the input. And all of us physicians have to admit—I certainly do—that the nursing staff has saved us on more than one occasion.
I also think that Team Care is important not just for the ED but for the entire Acute Care Continuum and beyond. I have seen this approach on the inpatient side where the providers get together with nursing, key ancillary services, and case management to discuss treatment and disposition of patients - even in some ICUs. This is another example of where the Team Care approach can be instituted.