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From left: Medical resident Michelle Fox, MD, and nurse Shelley Joseph, RN, discuss patient care on Tower 14B, a GMS unit.
When the patient census is high at BWH, speeding up the discharge process for patients who are ready to go home is one of the key factors affecting patient flow. If discharges are not efficient, the Emergency Department can become crowded with patients who need to stay there until an inpatient bed becomes available.
One area of focus for improving overall patient flow is the General Medicine Service (GMS). Often, discharges for general medicine patients are slow or delayed because these patients are located on seven different units on average and at times on up to 13 different units. This makes it difficult for patients' care teams to discharge them early in the day, despite being ready, so that beds are open as new admissions begin to come from the ED.
"Having a team's patients spread throughout the hospital results in poor communication among the care teams, especially between physicians, nurses and care coordinators," said Robert Boxer, MD, PhD, associate director of the BWH Hospitalist Service. "It's inefficient, and it doesn't promote the patient- and family-centered care that we at the Brigham are committed to delivering."
The combination of these factors led to the selection of GMS as a care redesign initiative, sponsored by Chief Medical Officer Stan Ashley, MD, and Senior Vice President of Patient Care Services and Chief Nursing Officer Jackie Somerville, PhD, RN.
For months, multidisciplinary teams including GMS physicians, nurses on med/surg floors, Admitting staff and ED staff have been working together to restructure the GMS model, which will formally launch June 20.
"The new model will create truly integrated, interdisciplinary teams, as physician teams will be associated with a single nursing unit," said Boxer, who is leading the GMS restructuring initiative. "With these new teams, we believe we will see significant improvements to communication, efficiency, patient safety and the overall experience for patients and families."
Each pod in the GMS units, which are Tower 14AB, 14CD and 10BA, will have a dedicated team of attendings and responding clinicians for both day and evening shifts. This regionalization will enhance communication among physicians and nurses, and it will provide more consistency for patients and family members. The physicians will have an opportunity to better get to know their patients, as well as the nursing staff on the units.
"This is all about interprofessional collaboration," said Associate Chief Nurse Nancy Hickey, MS, RN. "The team will round together on patients and include the patient and family in a way that coordinates, refines and executes the plan of care. Care will be more efficient, more collaborative and more patient- and family-centered with this new model."
Chief Medical Officer Stan Ashley, MD, said that the restructuring of GMS is a step forward for BWH. "Achieving regionalization of these patients will be challenging at times, but it's the right thing to do for our patients, our caregivers and the hospital," he said. "These changes will lead to improvements in efficiency, safety, quality, education and the experience of patients and their families at BWH."