DOME home
TOP STORY


-
-
-


-
-
-


-

-

 

 

Let the Revolution Begin


On Weinberg 4, nurse Karen Mitchell, center, helped develop an innovative care model that puts the patient in the driver's seat.

When her daughter was hospitalized in the Children’s Center for eight days following back surgery, Lisa Rowen was taken on a quick tour of a small kitchen, activity room and video library. Nurses, Rowen realized, assumed that she would be spending the night. From the start, they made her feel less like an interloper and more like a real partner on the health care team.

When her husband was a patient at a small community hospital, Donna Prow discovered a folding bed concealed inside the bedside table in his room. She, too, was encouraged to spend the night. Both Rowen, who is director of nursing for Surgery at Hopkins Hospital, and Prow, nurse manager of the surgical ICU in Weinberg, couldn’t help but wonder: If they can do it, why can’t we?

Since then, the delivery of patient care has been transformed on the Weinberg ICU and the big, 54-bed surgical inpatient unit on the fourth floor. It’s all part of a new model of care that puts the patient, not the provider, in the driver’s seat. Known as patient-centered care, this model embraces a free flow of medical information, 24/7 visiting hours and rooming-in. “We are not just accommodating families,” says Rowen. “We are welcoming them.”

It’s been more than a year since the new care model first rolled out on the WICU. It happened not long after nurses there learned an important lesson from the son of a critically ill patient. Because he visited every morning and was usually there during daily rounds, he gradually became more knowledgeable about his mother’s medical care. So when staff called him one night with some bad news (his mother required continuous dialysis), he said, “I understand perfectly. You don’t need to explain it to me.” And when she died, he was prepared. “He had become part of the team, and he understood how hard we had worked each step of the way,” says Prow.

Now WICU nurses involve patients and families in all aspects of medical care. During rounds, they introduce patients to the health care team by name. Families provide personal information that helps staff know their loved ones better. In December, visiting hours were opened around the clock. Bringing in social work and other resources as soon as patients are admitted became a chief goal. Measures like these pave the way for good, continuing care, says Prow, and could ultimately increase patient satisfaction, and decrease length of stay and even litigation.

Weinberg 4 seemed the next logical place to roll out patient-centered care, in part because that is where many WICU patients wind up. The new care model kicks off officially on May 3, but already change is tangible. Visiting hours, formerly from noon to 8 p.m., now are 24/7. Rooming-in is available if patients request it. “When family members room-in, we get a chance to teach them how to provide care,” says Karen Mitchell, an NCIII on Weinberg 4. “When it’s time for discharge, the teaching is already done.”

New chair beds, a lounge equipped with refrigerator, microwave and coffee machine, and a resource room with Internet access are among the amenities that help keep families comfortable. The chair beds and much of the equipment were funded by JHM’s Center for Innovation in Quality Patient Care, the organization that works to transform innovative ideas into reality. The center also provided a coach, who, among other things, developed a data-collecting tool to measure before-and-after satisfaction.

The new care model has been piloted in Weinberg because rooms there are spacious and private. “We will pass it on to other units wherever we can,” says Rowen, “but elsewhere in the hospital we are limited by semi-private rooms. Plus, there’s simply no space to convert to small kitchens and lounges.” Essentially, the model is a preview of what patient care might look like in the new clinical buildings. Already, says Rowen, support space—rooms where families could shower and store personal items, for instance—is on the drawing boards.

Patient-centered care is not a new concept. In 2001, it was identified as one of six foundations of quality care in an Institute of Medicine report, and it has been widely practiced in pediatrics. But it is all but nonexistent in adult med/surg areas, and that’s what makes the Weinberg project so unusual. As new clinical buildings open and Johns Hopkins Medicine continues to pursue ways to develop fresh strategies to keep pace with today’s imperatives of safety and quality, innovative care models like this one are likely to spread beyond Weinberg and to the Health System as a whole.

Anne Bennett Swingle

 

 

Johns Hopkins Medicine About DOME | Archive
© 2004 The Johns Hopkins University and Johns Hopkins Health System