(8) Transforming Care at the Bedside

When my mother gave birth to my youngest sister, the process felt more like a business transaction than a joyous gift of life. Our doctor was extremely dry and impersonal; not to mention we were rushed in and out as quickly as medically allowed. Of course, the excitement of my new baby sister outweighed negative thoughts I had for the hospital staff. Nevertheless, I will never forget my experience.

In July of 2003 The Institute of Healthcare Improvement (IHI) and The Robert Wood Johnson Foundation (RWJF) launched an initiative called Transforming Care at the Bedside (TCAB). The goal of this program is to "enhance the quality of patient care and service, create more effective care teams, improve patient and staff satisfaction, and improve staff retention.

The TCAB imagines each hospital room with a whiteboard and collage of the medical staff's pictures. On the bedside table is a notebook with common questions that the patient is encouraged to ask his or her doctors and nurses. At the end of each service, the patient will be given a write-up of everything that was done that day, including medications given, blood pressure, clinical results, surgical news, etc. The organizations emphasizes the importance of learning all of the patients' names and improving doctor/patient time by 70%. Whiteboards will display encouraging personal notes and goals for the patient to accomplish each day.

In the fall of 2003, three hospitals were selected as prototypes of this program: Seton Northwest Hospital (Austin, TX); UPMC Shadyside (Pittsburgh, PA); and Kaiser Foundation Hospital (Roseville, CA). In July of 2004, the organization had come up with over 200 ideas for the program, ranging from getting better equipment to giving patients more input in their treatment.

When the TCAB was officially started in 2005, it aimed to:

• Make care safe and effective
• Promote care team effectiveness and vitality
• Support and involve patients and families
• Increase value of care and care processes

Additional advancements of this project include:

• Night shift nursing rounds: Nurses check up on patients before the night begins and make sure they are properly set for the next 12 hours.
• Streamlined paperwork: GYN surgeons will use one universal post-operation evaluation sheet that includes medication instructions, lab work, and activity level.
• Skin Integrity cards: Nurses will keep small cards with a sketch of the human body that corresponds with their patient. They will circle areas of irritation in order to constantly monitor patients' skin.
• Patient self-medication: Option for patients to take medications on their own. Some thought it was empowering, and others were afraid.
• Revamped food services: Improving quality, variety, and flavor of food.
• Workplace Safety Enhancement: Making sure the staff is safe and free from harmful machinery or hazards.

The TCAB has not made its way to all hospitals in the United States. In 2004, only 13 major hospitals had integrated the program. In addition to my revamping efforts, I want to initiate the TCAB in every hospital I meet. Doctor/Patient relationships are vital to the positive atmosphere that I aim to create.

For more about the TCAB, click here.