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A variation on rapid response theme
Program focuses on non life-threatening issues
Spectrum Health, based in Grand Rapids, MI, has introduced a successful patient safety program called "Condition Concern" that its proponents say offers a unique approach to patient and family involvement in expressing concerns they have about care. The program was described in a recent article in the Journal of Nursing Care Quality.1
What makes the program so different is that when concerns are expressed, they are not relayed directly to the rapid response team, as in other facilities, but rather to an administrative associate manager (AAM), or house supervisor, via an emergency phone number provided to patients and family. The AAM then determines whether emergency medical care is required by the rapid response team, or whether the situation is something that can be addressed by another type of intervention which often resolves the problem "on the spot."
In fact, notes Sylvia K. Baird, RN, BSN, MM, nursing quality manager and lead author of the article, "As of the end of December we have had about 140 calls and of those calls, 76%-78% are resolved immediately."
NPSG lends impetus
One of the dynamics that led to the creation of the program was The Joint Commission's National Patient Safety Goal 13, which encouraged patients to participate in their own safety. "Sylvia and I were having a conversation about the goal," recalls Lynn Bobel Turbin, MSN, RN, CCRN, NE-BC, director of adult critical care, and a co-author of the paper. "There was minimal literature available on the topic to guide us, but I did go to an IHI symposium, and one of the sessions talked about what one hospital (Virginia Mason in Seattle) did with rapid response teams and patient and family concerns."
However, adds Turbin, who also runs the rapid response team program, "We had also done some process improvement with our rapid response team, and we were reluctant to use that vehicle as the one to respond to patient and family concerns. We wanted them available, but not initially."
"We did not know what types of calls we'd be receiving," adds Baird. "We wanted to gather some information [before alerting the rapid response team]; we only wanted the rapid response team to respond to serious clinical events requiring immediate intervention."
In looking at programs like the one at Virginia Mason, she notes, most of the calls initiated by patients and family did not involve life-threatening issues (the data from their own program has shown a similar pattern). "Our goal was to set up a mechanism where they'd be involved in their care, and given a voice," Baird explains.
So, a task force was formed to decide the best approach to take. "We decided on having the clinical house supervisor as the first responder to a Condition Concern alert; they are RNs," notes Baird.
"One of the members of the task force was the head of patient relations, and she and her members had received some calls [from patients and family members], so that gave us information on what these calls happened to be, and where they should go first," adds Turbin, who led the task force. "We knew that most places that had operationalized this approach used a rapid response team as that first responder, but we wanted to test the waters and not 'go for the gusto' immediately and the data has confirmed we were right."
But before the program could be launched, it had to be "sold" to hospital leaders, including several quality committees, through a series of meetings and PowerPoint presentations. "We presented to the hospital board, quality, lay people, professors, administration, and physicians," says Baird. "We presented back into our clinical quality improvement committee, the executive quality committee, which reports up to the board, and clinical relations."
Paving the way
The task force developed an information packet for each of the clinical areas, says Turbin. "Each included a 'to-do' checklist for managers, and scripts we developed for meetings; we wanted staff to tell patients about the program during orientation," she explains. "We had a brochure in the welcome packet and signage in the rooms that instructed patients to call the alert number if they had concerns they felt were not being addressed by their primary providers."
The program was implemented in July 2009. "When the AAM gets a complaint, they go to the unit and have a dialogue with the staff; they tell them they've just received an alert from 'so and so,' and ask if they know why they may have called," says Turbin. "Sometimes they do, but other times they don't."
Then she continues, the AAM decides who shall accompany them to talk with the patient. "A majority of the time they do it independently," says Turbin.
"Most of the time these issues can be resolved immediately," adds Baird. "In some case they might just want more discussions with the doctor, so the AAM facilitates that, or they may not be satisfied with their pain control, so they'll work with the nurse and the doctor."
Baird says she is pleased with the results to date. "I believe we have provided a mechanism for patients and family to have another voice, and we're extremely pleased that those things they're concerned about are things that can be problem resolved on the spot," she says.
Of course, not all such problems can be resolved, and there have been a few cases where the complaints were not satisfied, notes Turbin. "Someone may have wanted access to a medical record that did not have permission to get it, or they saw an episode of 'Grey's Anatomy' where a patient with a similar condition had surgery and the patient wanted it too, but in their particular presentation it was not indicated," she says.
Turbin is convinced this program can be replicated at other facilities. "So many institutions have [clinical] management folk around all the time," she notes. "If they do not have them during the day, they have some sort of house supervisor, and with that staff population it's certainly doable."
[For more information, contact: Sylvia K. Baird, RN, BSN, MM, Nursing Quality Manager, Spectrum Health, 1840 Wealthy SE, Grand Rapids, MI 49506. Phone: (616)774-7728. Fax: (616) 774-7904. E-mail: email@example.com]