We had a great time at the National Association of Orthopedic Nurses Annual Congress this week. Below are some of the challenges, solutions, and priorities we heard echoed in conversations with attendees:
- Continuity of care and care transitions
Clinic-to-hospital and vice-versa communication gaps can create a disjointed process and lead to patient confusion and misaligned expectations. It’s best to sit everyone down in a room and come up with a single care plan across the entire patient journey. When teams take the time to do this, it’s amazing the kinds of efficiencies and gains that can come out of a single session.
- Length of Stay / Throughput
In the new era of bundled payments, hospital stays need to be as lean and efficient as possible while still maintaining quality care. Mobilizing patients as soon as possible keeps LOS in control. Understanding and mapping to insurance coverage helps too. Also, senior staff who take the time to walk through the entire process in the “patient’s shoes” can find a lot of holes and opportunities for improvement.
- Patient Satisfaction (HCAHPS) including pain management
The reward and penalties in new value-based purchasing arrangements have hospital c-suites looking at patient satisfaction from top to bottom, from the admitting experience to the food service to 30 days post discharge. Nurses have found the pain management measure one of the toughest to tackle. Those who are able to engage their patients in a “pain pact” sort of partnership with agreed goals tend to fare better.
- Discharge Process / Re-admissions
Some hospitals have consolidated and streamlined their discharge activity by doing discharge instructions with groups of patients. They are reporting that discharge goes a lot faster and is much more thorough than when they do it patient by patient. Recurring reinforcement after they leave the facility with backups for “lost” instructions, along with comprehension evaluation is also helpful.
- Nurse Callbacks / Triage / Staff efficiencies
Coordinators are fielding anywhere from 5 to 20 calls a day from patients with questions. Some hospitals have made joint education class attendance mandatory, others have a series of phone calls set and employ up to 2.5 nurse navigators to handle the load. Service lines are actively implementing and promoting online access to educational materials in an effort to reduce call volume and recover productivity.
- Setting Patient Expectations / Surgery Preparation
When patients are not prepared or expectations are set too high is usually when programs run into trouble, for example a doctor telling a patient they can go to rehab when it is most likely they will be discharged home. Some hospitals have turned to standardized scripting to make sure their clinicians and hospital staff are all speaking the same language.
- Volume Decline / Market Share
A hospital’s bottom line can depend on the volumes of one or two of their orthopedic surgeons. Today service lines need to maximize their physician relationships and be sure to differentiate their program in a competitive environment.
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