Assuring patients have the appropriate length of stay is focus of daily care coordination meetings
A stay in a modern hospital is a complex orchestration of procedures, tests, medications, consultations, therapy and ancillary services, all coordinated by a multifaceted team of caregivers. The ultimate goal is for each patient to follow a predictable course of treatment and to be discharged after a stay appropriate for their initial condition.
Even slight delays or a missed step in any of these processes can end up with a patient’s discharge being delayed. Delaying discharge is dissatisfying to patients and it prevents access to care for patients waiting to be admitted. To help care teams better coordinate a patient’s care, Barnes-Jewish Hospital launched daily care acceleration meetings (DCAMs) on most nursing units in 2014.
DCAMs are planning discussions held on nursing units that focus on each patient’s goal for the day and his or her projected discharge date and post-discharge destination. The goal is the smooth and timely admission and discharge of patients and appropriate length of stay.
DCAMs are the creation of BJC HealthCare's Making BJC Better initiative, which is helping Barnes-Jewish Hospital and other BJC hospitals find ways to operate more efficiently and effectively.
"Every month, we are unable to accommodate all of the requests for transfer patients from other hospitals to Barnes-Jewish Hospital due to limitations in our bed capacity," says John Lynch, MD, Barnes-Jewish Hospital chief medical officer. "We can work better as a team in planning for the next steps in a patient's care, which will allow us to create an exceptional patient experience and care for more patients who need the high-level of services we are able to provide."
One of the primary benefits to patients is that their families have better assurance of a discharge date and can better plan for at-home support, transportation or can plan for discharge to another facility. Patients also benefit through more consistent communication among their care team who collaborate on their plan of care.
Although skeptical at first, many units, including general surgery units 6400/6500, are embracing the new process. Lead Charge Nurse Stephanie Spickerman, BSN, RN, likes how DCAMs strengthen communication among the entire team. “There is less confusion about each patient’s plan of care, which benefits them clinically and increases their satisfaction,” says Spickerman.
One would think that with all of the changes and challenges in the health care environment, asking care givers to add one more task to their day would meet with resistance. But on 6400/6500 the general consensus is that the DCAM is "time well spent."
"I like knowing the anticipated discharge date," says Kelley Schuster, BSN, RN, staff nurse on 6400/6500. "When I talk with the patient and family, I have more credibility. If I don't know the answer to their question before the meeting, I will definitely have the answer after."