The Institute for Healthcare Improvement (IHI) in collaboration with the Robert Wood Johnson Foundation has just released a white paper entitled Transforming Care at the Bedside (IHI, 2004). In response to the recent care challenges experienced throughout the United States healthcare system, these two partners worked with 13 institutions across the nation to develop a framework for improving change in hospitals and clinical office settings in four main areas: safety and reliability, care team vitality, patient-centeredness, and increased value. Although the intent of the white paper is to address care issues for patients in medical/surgical units in the hospital setting, many of the proposed measures for transforming care at the bedside (TCAB) are applicable in the gastrointestinal (GI) endoscopy and clinic setting.
For instance, the TCAB goal for safety and reliability is: "Care for patients who are hospitalized is safe, reliable, effective, and equitable." This goal is certainly a major focus of GI nurses. Efforts to monitor patient safety during invasive procedures, attention to the patient's response to anesthesia and treatment during and after the procedure, as well as after discharge, and identification and assessment of patient outcomes related to the patient's endoscopic care are all examples of GI nurses' attention to this goal.
The TCAB goal for care team vitality is: "Within a joyful and supportive environment that nurtures professional formation and career development, effective care teams continually strive for excellence." The Society of Gastroenterology Nurses and Associates (SGNA) provide the support and resources for GI nurses to further their career and develop excellence in professional development and patient care. In addition, SGNA members have shared their stories of celebrating the specialty on GI Nurses and Associates Day, often setting up special presentations to draw attention to their department and care team. Certification is another example of how gastroenterology nurses meet the TCAB goal of striving for excellence.
The TCAB goal for patient-centeredness is: "Truly patient-centered care on medical and surgical units honors the whole person and family, respects individual values and choices, and ensures continuity of care." Gastroenterology Nursing has often published stories supporting this goal in the "Patient Perspective" column. Gastroenterology nurses have shared in this column how they supported patients through difficult decisions and healthcare challenges. Patients have also shared in this column their own stories of receiving "patient-centered" care during interactions with the GI nursing community. Gastroenterology nurses meet this goal through their ongoing continuous quality improvement programs. Attention to waiting room wait times, the patient's sedation experience, the discharge process, and patient follow-up after discharge are just a few examples of ongoing monitoring of patient experiences to facilitate greater patient and family satisfaction during the endoscopic care experience.
The final goal, increasing value, states: "All care processes are free of waste and promote continuous flow." This goal gives attention to efficiency so that nurses and other caregivers can provide more direct patient care. The IHI white paper clarifies eliminating waste can mean "anything from redesigning work processes to redesigning physical space." The SGNA Minimum Data Set (2005) is an example of how GI nurses nationwide participated in developing a more efficient and thorough resource for patient documentation and data retrieval in the endoscopic setting.
It is encouraging and timely to see national attention to the challenges of healthcare delivery today. The IHI Transforming Care at the Bedside is an important resource for medical/surgical care teams in focusing on priorities for promoting quality care experiences for patients and providers in the medical/surgical setting. The gastroenterology nursing community, while already demonstrating many of the TCAB goals, can benefit from adopting and adapting the goals to direct their quality improvement objectives in the GI endoscopy setting. Commitment and attention to improving care environments, not only for the patient and family, but also for the healthcare providers working in these settings, can lead to improved care and satisfaction for both patients and their caregivers. For more information about Transforming Care at the Bedside, visit http://www.ihi.org/IHI/Topics/MedicalSurgicalCare/TransformingCare or http://www.RWJF.org.
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