"One-Stop Shopping" Care Delivery - Bringing Coordinated Children's Ambulatory Services to Life

Purpose:
To create a child-friendly environment where complex ambulatory care may be coordinated and rendered in one location,during one visit, by specialty teams of multi and interdisciplinary care providers.

Relevance/Significance:
Care delivery for complex pediatric outpatients improved through consolidating care into one site with coordination of services to provide one site/one visit service. Involved relocating more than 50 clinical programs in 7 geographic locations into a new facility. New processes & systems improved care coordination including, patient centered scheduling; addition of therapies, radiology, audiology, infusion center, pharmacy, patient tracking, revision of operations to optimize patient flow.

Strategy and Implementation:
Bringing new facility to life with attention to collaborative practice in design; Initiated planning teams with representation from all user groups; modified flow and care space use to remove bottlenecks, based on input from nursing;used systems engineering approach to understanding clinic flow/exam room utilization enabling us to find opportunities for adding sessions or new programs ;added services (therapies, radiology, surgery, infusion center, pharmacy, education)to support care delivery model of "one stop shopping"; developed patient tracking system to improve efficiency of patient flow, improve staff communication; developed patient centered scheduling system to improve schedule to visit times and to reduce no shows; improve patient/family satisfaction in creating a user friendly environment where care is delivered in one location during one visit; creation of child friendly environment with attention to storytelling/reading/learning at all ages.

Evaluation:
Press Ganey Pt satisfaction score improved by 23 points. Transistioned to CGCAHPS and in 3 months demonstrated a 51 point percentile improvement. No show rate reduced by 50%. RN Pulse Survey showed improvement in engagement to meet Magnet Standard. Perceived reduction in medication errors. Improved efficiency in room use to meet standard for complex pediatric care to one patient per room per hour.

Implications for Practice:
Included clinical nurses as participants in planning and design which positively affected functionality of the environment of care. Inclusion positively impacted nursing engagement and satisfaction and was key to optimizing use of space and patient flow.