When the TCAB initiative was initiated at Roseville 18 months ago with the Robert Wood Johnson Foundation and the IHI, the Roseville staff had no idea of how much could be achieved—from enhancing patient care to improving both physician and nursing satisfaction to decreasing patient mortality. Although the TCAB initiative is viewed as an ongoing journey, the staff is eagerly anticipating the remainder of the voyage.
An example of an initiative at other hospitals among the 13 includes “peace and quiet time” at Long Island Jewish/North Shore. These nursing “magnet” hospitals discovered when they surveyed their patients that noise preventing patients from resting and recuperating was a major problem. Beginning with 30 minutes of enforced quiet time in the afternoon and then expanding to an hour, patients have reportedly been delighted with this. Snacks were passed out to the patients so they would buy into the initiative and believe they were not being ignored—a floor staff suggestion!
Another hospital modified the usual “multidisciplinary rounds” into highly functional, true patient rounds. At this hospital they originally were called “discharge rounds,” with a focus on discharging the patient. Recognizing that the patient had not been involved because these occurred in a conference room, they were renamed “patient care rounds” and moved out of the conference room to round in the patients’ rooms. Following the dictum of “nothing about the patient without the patient,” these rounds include a pharmacist, a social worker, the charge nurse, a nutritionist, a case manager, and the patient in the patients’ room. This team rounds on all the patients on the unit, seeing up to 37 patients in 1 hour! After initial difficulties involving the residents, they now have “firm directors,” so a physician is now involved. Based on this experience, they proclaim that their culture has changed from “no, it won’t work” to “why not try it?”
Hospitals and staff participating in TCAB are discovering just how successful they can be in achieving enhanced communication, implementing novel interventions to improve care, and optimizing the overall hospital experience for patients.