Читать книгу Kelly Vana's Nursing Leadership and Management - Группа авторов - Страница 239

Nurses who work on an Orthopedic Unit notice that their patients have a longer length of stay after hip replacement surgery than the national average. They use QI tools to understand this variation and determine that an underlying cause is inconsistent patient preparation prior to surgery. Some patients anticipate a speedy recovery and have not identified the help they will need after discharge. Other patients expect to be admitted to a rehabilitation unit to recover after surgery, which may not be indicated for the procedure. These situations result in discharge delays while the unit's nurse case manager arranges for family help, home care services, or rehabilitation services. The nurses work with other members of the interprofessional team, including physicians, physical therapists, and occupational therapists, to design a test of change. They create a patient education video that clearly outlines recovery expectations and guides patients in establishing a post‐discharge plan of care.

After implementing the intervention, they note that length of stay has decreased and there are still opportunities for improvement. The team designs another test of change. In addition to the video, each patient also receives a call from the nurse case manager to answer questions and discuss and document the plan of care. Again, the team sees a decrease in length of stay and continued opportunities. The team designs a third test of change. The day before the surgery, a nurse from the Preadmission Testing Unit (PAT) calls the patient and verifies the plan of care that the patient developed with the nurse case manager. If the plan is still in place and appropriate, the surgery is performed as scheduled. If the plan needs to be changed, the PAT nurse notifies the surgeon and nurse case manager and they work together to resolve the issues. After implementing this test of change, length of stay for patients having total hip replacement surgery is lower on the orthopedic Unit than the benchmark, and the team also sees a decrease in 30‐day readmission rates.

1 What was the original opportunity that the nurses wanted to improve?

2 Why was it important for the nurses to work with the interprofessional team to address this opportunity?

3 Why did the team elect to conduct three tests of change rather than implementing everything at once?

4 Why was the use of a patient video partially effective in reducing length of stay for patients after total hip replacement surgery?

5 Why did the conversation with the nurse case manager improve the length of stay for patients after total hip replacement surgery?

6 Why did the call from the PAT nurse further improve length of stay?

7 What factors may have resulted in the decrease in the 30‐day readmission rate?