Standardizing Care Delivery
The last section of this resource room reviewed the role of the multi-disciplinary improvement team to understand care processes, identify gaps in performance and propose and implement interventions. However, it ultimately all improvement initiatives live in the multi-disciplinary care team that delivers patient care. One conceptual model that integrates the various levels of Heart failure care delivery is the Hospital Care Conceptual Flow Diagram, submitted by Jason Stein, MD from Emory University School of Medicine.
A model for bedside teamwork is essential in delivering effective patient care and uncovering the important heart failure care management issues on a daily basis.
A model for teamwork that relies on asking three questions each time any patient is evaluated. The model is useful for all patients in hospital and may especially be useful for patients with heart failure.
It relies on establishing goals, clarifying roles, understanding tolls, and identifying holes (in patient care management and/or the care plan. However, the cognitive process outlined in this model is inadequate without a tool to document the action steps. Establishing a framework for the type of work the team should be participating in is very important. The Inpatient management worksheet in the clinical tools section of the room is a tool that can be placed on a chart and clarifies the goals for the day. In addition it can serve as a vehicle for communication among care providers.
Moving from the conceptual to a specific tool or intervention is critical in moving improvement efforts forward. However, this shift can be difficult and relies on the principles outlined previously, and on a clear understanding of the current processes involved in patient care, as well as an understanding of the waste and re-work that is present. So, when a new intervention is proposed it results in overall more efficiency rather than being viewed as just additional work.
As the Improvement team is identifying gaps in care, another important area for standardization is the knowledge of the myriad clinicians involved in the care of the patient. At many institutions hospitalists are the primary physicians who manage patients with heart failure. To help facilitate standardized practice, the task force developed a set of three checklists:
- Admission checklist
- Daily rounding checklist
- Discharge checklist – will be discussed further in Discharge and Follow-up Section
Sample heart failure order sets are also available in the clinical tools section for review and to be used as a starting point. However, any implementation plan that does start with an understanding of processes of care is doomed to fail or be minimally successful. The interventions themselves may be modified over time with feedback from users and review of impact of selected patient outcomes, but a lack of understanding of the care delivery processes must serve as the foundation for improvement efforts.
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