I was 23 years old at a baby shower for a coworker, Dave. We sat down together and ate our cake.
I was young, and children were not on my radar, but I will never forget what he said to me.
“Before you have a kid,” he said. “You should get a dog to help teach you responsibility.”
To that I replied, “Sounds good, what kind of dog do you have?”
“Oh, I don’t have a dog – I don’t have time for that kind of thing,” he replied.
I laugh every time I think of this story. It also reminds me that sometimes you just have to do it – whatever it is. Just like my friend Dave did.
The just-do-it approach is one that many hospitals will need to take when they want to do process improvement, such as creating nurse-ready rooms.
In my last article, I explained what a nurse-ready patient room is. As a reminder, a nurse-ready room is properly cleaned and staged with patient-specific equipment and supplies, so nurses can deliver exceptional care at the top of their license.
A nurse-ready patient room is created in nine steps:
Communicate the needs of the nurses to the support services teams.
Define a standardized patient room set-up by nursing unit.
Organize clean supply and equipment rooms per the nurses’ needs.
Create room turnover documentation so that you can understand how teams work together to complete the task.
Ensure all teams are aligned on workflow goals, and adjust support services team responsibilities accordingly.
Implement technology to drive the room turnover process.
Continue to improve the partnership between nursing and support
Use metrics to improve room turnover as time goes on.
Celebrate because you now have 100 percent nurse-ready patient rooms!
In this article, I will cover these steps in more detail, and the results you might see from implementing nurse-ready rooms based on actual results from a case study.
The Goal: Nurse-Ready Patient Rooms
It was 2015, and I was the director of operations planning at University of California-San Francisco (UCSF) Health. We were building a new children’s hospital, and I was working closely with Kim Scurr, RN, and vice president of operations at UCSF Benioff Children’s Hospital.
Her mission in the project was to ensure no bad habits from existing facilities were transferred to the new facility, such as patient rooms that were constantly unprepared for nurses.
Inspired by hospitals like Northwestern Medicine Central DuPage and Kaiser Permanente, we laid out the following objectives to create nurse-ready rooms in the new UCSF Health facility:
Use electronic room turnover checklists by unit and room.
Ensure equipment staging was aligned with room setup.
Track metrics to sustain changes and drive improvement efforts over time.
The goal? Make sure each room was ready for nurses to deliver exceptional patient care.
Implementing nurse-ready rooms can directly impact your nursing staff’s day-to-day work experience. New patient admissions take focus, and can be stressful on their own. Why not set up that process to be more successful with a perfectly prepared patient room?
9 Steps to the Nurse-Ready Patient Room
From my experience at UCSF Health, and case studies from other hospitals like Kaiser Permanente, here are the three stages and nine steps to ensure nurse-ready rooms.
- Open the lines of communication: Communicate nurses’ needs to support services teams, like environmental services and material services / central supply. It is not unlikely for these teams at many hospitals to have no idea what the nurses prefer in a room setup.
- Standardize operations: Work with the support services teams to define a standardized patient room setup for each nursing unit.
According to one case study at Kaiser Permanente, this includes ensuring necessary equipment and supplies are always present such as:
- Bed with scale
- Vital sign machine including thermometer, pulse oximeter, BP cuff
- Suction canister
- O² flow meter
- IV pole
- IV pump(s)
- Slip sheet
- Clean linens, gown, patient bath kit
Case-specific equipment and supplies include:
- Telemetry box
- Wall monitor cables
- Electrogram wires
- SCD machine
- Kangaroo pump
- Accumax pump
- PCA pump
- Seizure pads
- Organize materials: Organize clean supply and equipment rooms with material services per the nurses’ needs. For example, have the equipment stored or laid out exactly how nurses would like to see it in the room.
- Document workflows: Create room turnover documentation so that you can see how the interconnected teams work together. This step in “lean” process improvement is called “defining the value stream.” Here, standards from Step 2 turn into real gains.
Here is a sample nurse-ready room workflow that incorporates my company’s application, ReadyList:
Image source: Nurse-Ready Patient Room Workflow, ReadyList
- Align goals. Ensure all teams are aligned on workflow goals, and adjust support services teams’ responsibilities accordingly.
For example, instead of the nurses, can support teams handle ordering missing patient equipment, and reporting facilities and technology issues that are discovered during room turnover?
- Implement technology. To increase efficiency, consider technology that can help support the room turnover process. It is inefficient to drive operations at this scale by hard-to-read paper checklists or whiteboard scribble.
7. Ongoing partnerships. Continue to improve the partnership between nursing and support services.
For example, nurses on one UCSF Health nursing unit noticed that IV pump power cords were disappearing. Given the strong working relationship between Nursing and Environmental Services, the solution was for the environmental services technician to add a step to their workload, and order a power cord to the room if missing.
8. Use metrics. This is another benefit to using technology to drive nurse-ready patient rooms. When you have access to metrics, you can optimize your room turnover efforts as time goes on.
This is an important step. When you do not have access to metrics, you do not know how you are actually doing. Metrics can be a huge motivator for keeping the program going, too.
9. Celebrate! Now you have 100 percent nurse-ready patient rooms, so nurses can focus on delivering exceptional patient care, not chasing down supplies or cleaning up after the last patient.
We saw the following results over a three-year period at the UCSF Benioff Children’s Hospital upon implementing nurse-ready patient rooms.
Nurses waste too much time performing workarounds in their day to day. (You can read more about that in this recent article on nurse workarounds.)
At UCSF Health, we addressed a big workaround: the missing infusion pump. As a result of our efforts, support teams now order IV pumps ahead of time through the technology they use to drive room turnover (via my company’s web application, ReadyList).
This has shifted 76 percent of total orders (1,164 orders annually) away from the nurses.
With the average IV pump order taking about 2.5 minutes, UCSF Health nurses gained about 250 patient-care hours annually under the new workflow.
Faster Room Turnover
With wasteful steps eliminated, and lean operations implemented, UCSF Health sustained a 7-minute reduction in room cleaning time despite support services teams taking on additional responsibilities.
Improved Infection Prevention
When you have standardized best practices in room cleaning, you can dramatically reduce hospital-induced infection rates. UCSF Health experienced a 56 percent decrease in C. difficile cases.
This represented 33 percent fewer C. difficile cases on average than the hospital’s sister campus that had not yet implemented the nurse-ready patient room model.
Fewer infections are better for patients and hospital revenue, too. Hospital-induced infections like C. difficile can trigger $42,316 in non-reimbursable costs to a hospital.
My final thoughts are this: It is not uncommon for hospitals to get excited about implementing the nurse-ready room model, only to let it fall apart a few months later as they move on to the next project.
The results you see here are as a result of a hospital committing to this model for years and having the metrics from which to optimize. The nurse-ready room model is still going strong today at UCSF Health.
One last piece of advice: There really is not a “right” time to disrupt and improve your operations. Just like the story about my friend Dave and his approach to having children, you just have to go for it!
For More Information
If you are interested in more content on this topic, you can check out our videos on nurse-ready rooms here:
Brian Herriot is a hospital operations leader and CEO of ReadyList, Inc. ReadyList software ensures fully operational clinical environments to help clinicians dedicate more time to their patients.