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Improving the Universal Bed/Acuity-Adaptable Care Delivery Model on the Cardiac Surgical Unit at St. Luke’s University Hospital:

Improving the Universal Bed/Acuity-Adaptable Care Delivery Model on the Cardiac Surgical Unit at St. Luke’s University Hospital Nicholle Daley Widener University NURS 440: Leadership and Management for the RN Dr. Lorraine Igo , MSN, RN Dr. Stephen Oliver August 14, 2017 Submitted in partial fulfillment of the requirements for the Bachelor of Science Degree in Nursing, RN-BSN Program Widener University


Introduction St Luke’s University Hospital – non-profit, regional, fully integrated, nationally recognized network providing services at seven hospitals and more than 200 sites Location – Lehigh, Northampton, Carbon, Schuylkill, Bucks, Montgomery, Berks, and Monroe counties in PA and Warren County, NJ This plan focuses on the Bethlehem Campus (which is considered the main campus) 540 beds and 27,426 admissions last year (“St Luke’s – About,” 2017)

Introduction Cont.:

Introduction Cont. This plan focuses on the cardiac surgical unit at the Bethlehem Campus. 31 bed unit Adopted universal bed model when reconstruction of unit took place five years ago. This unit is one of two units designed based on the universal bed model at the Bethlehem Campus.

What is the Universal Bed/Acuity-Adaptable Care Delivery Model?:

What is the Universal Bed/Acuity-Adaptable Care Delivery Model? The model is based on the concept of patients spending their entire length of stay, from admission to discharge, in the same room. Designed to improve patient outcomes, eliminate patient safety concerns that stem from multiple patient transfers, decrease overwhelming nurse-to-patient ratios seen on general care floors, and provide a healing environment These universal rooms must be able to accommodate any acuity or level of care, including critical care, telemetry, or med-surg. (Evans , Pati , and Harvey, 2008 ).

Current Model at SLUH:

Current Model at SLUH Not consistent with true universal bed/acuity-adaptable care delivery model. Only six beds out of thirty-one are equipped for critical care acuity. Patients stay on the same unit from admission to discharge, but not the same room. Patients who receive open heart surgery are admitted into a critical care room, once patient is stable and recovering, patient is moved into a room adapted for telemetry acuity. Nursing staff is broken up into critical care nurses and telemetry/step-down nurses.

Process of Current Model:

Process of Current Model

Issues with Current Model:

Issues with Current Model All of the nurses on the unit are not critical care trained leading to: Nurse burnout and dissatisfaction Complicated/unorganized staffing High turn over rate Not enough critical care beds, which leads to: Moving patients out too early from critical care Complications Readmission into critical care Chaos and organization when there are high volumes of heart surgeries

Proposed Plan:

Proposed Plan

Staff Recruitment and Development :

Staff Recruitment and Development All nurses on the unit become cross-trained for critical care Share responsibility of all patients on unit Rotation between all acuities Give all nurses opportunity to ask questions and obtain information about new program Educational process to educate all new nurses 1 year contract nurses must sign to stay on the unit


Support from Physicians Educate physicians on the complexity of the model of the unit Make them more aware of the challenges of the unit Put staffing into perspective for them More consistent heart surgery schedule To help ensure there are rooms readily available So patients aren’t rushed out of critical Support from Management Have adequate staff for all acuity levels On days with high volumes of heart surgeries schedule a PRN nurse to help transfer patients out of critical care rooms and set up for oncoming patients This will help the transfer of patients move faster Enforce new plan and help train new staff

Multidisciplinary Development Team:

Multidisciplinary Development Team Consists of: nurses, nurse manager, supervisors, surgeons, respiratory care, social services, home care, pastoral c are, nutrition, education, cardiac rehabilitation, anesthesia, and pharmacy Work together as a team to facilitate healing and transfer of patients Develop guidelines for care: development of a critical pathway, revisions in policies and procedures, information for patient’s education, orders, discharge planning process, and staffing patterns Plan to meet three times a week to review progress of each patient Review plan for discharge, follow-up care and referral to appropriate healthcare members

Education for Patients and Families:

Education for Patients and Families Educate patients and families on the universal model How it works What to expect Educate patients and family on the process of each step of recovery from post anesthesia to discharge Begin discharge teaching from the beginning Ensure they understand there is limited critical care rooms, and they are meant for the most acutely sick patients

Challenges :

Challenges T he design of the unit and the rooms Unable to make every room critical care adaptive Time, money, and more construction Resistance to cross-training Nurses might not have an interest in training in critical care

Anticipated Benefits:

Anticipated Benefits Improve efficiency and continuity of care Improve flow of patients out of critical care rooms and into telemetry rooms Improve patient, family, and nurse satisfaction Patients will be better cared for because every nurse has critical care training Decrease length of stay, decrease infection rates, better discharge planning and education, decrease morbidity and mortality, decrease post-op complications Improve collaboration between all members of the multidisciplinary team

Leadership and Communication Approaches:

Leadership and Communication Approaches Leadership styles transformational and complexity Value collaboration Help each other advance to a higher level Motivate and inspire each other Transactional When structure and order is needed Reprimand staff if not following new plan Communication approaches Collaboration Conflict management

Evaluation :

Evaluation Evaluate critical care training and competencies of nurses Evaluate patient and family education Evaluate effectiveness of the multidisciplinary team approach by evaluating patient stays, discharge planning, and patient outcomes Evaluate support from physicians and management Are they taking new plan into considerations Evaluate the flow of transferring patients and the organization of the unit


Conclusion The Universal Bed/Acuity-Adaptable Care Delivery Model on the Cardiac Surgical Unit at St. Luke’s University Hospital has caused many issues including Nurse burnout and high turn over rates Unsafe patient practices Disorganization and chaos when trying to transfer patients This plan is to help solve these issues and help develop a more efficient way to run the unit to improve satisfaction among patients, families, and staff


References St. Luke’s – About. ( n.d. ). Retrieved August 14, 2017, from Miller, Evans, Pati , & Harvey. (2008, March 31). Rethinking acuity adaptability. Retrieved July 22, 2017, from / Clark, E. I., RN, MS, CCRN, CCNS, Roberts, C. L., RN, MS, CCRN, & Traylor, K. C., RN, MBA, CCRN. (2004). Cardiovascular Single-Unit Stay: A Case Study in Change. American Journal of Critical Care,13 , 5th ser., 406-409. Retrieved August 14, 2017

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