Improving Patient Outcomes Utilizing a Primary Nursing Care Delivery Model

Purpose:
An initiative was brought forward to decrease the delay in assigning in-patient beds so as to improve patient flow through the organization as well as provide immediate patient care on the Intermediate Cardiology Unit. We also aimed to improve RN-RN communication, collaboration, and accountability.

Significance:
In a high volume patient care environment challenges are placed on nursing to increase the # of patient admissions, transfers, & discharges in a timely manner, presenting significant barriers for optimal patient flow. Nurses voiced a new all RN Care Delivery Model to enhance patient flow & quality.

Strategy and Implementation:
A committee of bedside clinicians identified barriers to patient throughput. The common issues presented were RN to patient ratios, free charge to support throughput & patient placement, delays to vital signs, number of lab draws & support for ambulating & transferring patients. The committee presented an all RN care model to Nurse Executive Committee that would take into account all identified barriers to lead to success. 17NT was chosen for a variety of reasons. Pilot started March 8, 2011. Nurse to patient ratios was decreased to 4:1 on both shifts, free charge on all shifts, phlebotomy for all morning lab draws. The PT team was identified to assist with mobilization of patients. Bedside report was instituted to increase communication between RN's & patients in the participation of their plan of care. This was hypothesized to increase patient and nurse satisfaction by addressing patient needs and placed RNs on the floor during frequent patient call bell times.

Evaluation:
Success of the RN model pilot: Pressure ulcers dropped from 4 to 0 in 1 quarter; emergency pt events went from 6.15 to 2.02 events/1,000 pt days; pt falls reduced from 20 to 9 in 1 quarter; pt. satisfaction increased in all areas; RN satisfaction based on the NDNQI RN Survey is "high satisfaction."

Implications for Practice:
Our nurse led RN Care Delivery Model pilot can be implemented at any organization through a shared governance vehicle and bedside clinician input, drive, and application, support by leadership.