Where patients join the team
Date: February 7, 2011
Bridgeview Acute Medical Unit.
Nurse Launa Theodore joins her care team in front of the elevators, waiting expectantly for what has become a ritual in patient care at the Bridgeview Acute Medical Unit. The doors slowly open and the team greets patient Joseph Pietkiewicz and gets down to the business of providing care. But this is more than just a welcome. It’s a way of saying to Pietkiewicz that he and his family are part of the team who will decide how treatment will unfold.
This concept of patient- and family-centered care is woven into the fabric of the patient experience on the Bridgeview unit at Johns Hopkins Bayview Medical Center. “We want our patients to know that they are special and it’s our pleasure to care for them,” says Theodore.
Deemed a “learning lab,” Bridgeview is exploring this new model of patient care and applying it to the work done on the unit every day. This requires careful collaboration from staff members in many different departments, from hospitalists, nurses and case management to social work, nutrition and environmental services.
Cynthia Rand, deputy director for patient-centered care in the Department of Medicine at Bayview, is leading a workgroup and moving forward on initiatives that help health care professionals learn, refine and develop patient- and family-centered innovations. “On Bridgeview, we’re emphasizing active learning,” says David B. Hellmann, vice dean of Johns Hopkins Bayview Medical Center and director of its Department of Medicine. “We’re taking good practices and making them better.”
“Bettering” Bridgeview began with a new unit design. Bright and airy, Bridgeview also is home to three kitchenettes that stay open for patients and families 24 hours a day, seven days a week. Instead of a single, central nursing station, there are three—one at the beginning of each of the three hallways. “Gliding chairs and small sofas set near the windows give patients and their families a chance to get out of their rooms and into the sun,” says patient care manager Rona Corral. In patient rooms, televisions are at the bedside to reduce noise. The waiting room is equipped for children with a small table and chairs, games and books. All staff members are welcome to use the multidisciplinary workroom to help facilitate discussion and problem-solving.
But the real imprint of the new care-delivery model puts staff at the forefront of change, starting from the moment the elevator doors open on the unit. Each newly admitted patient is personally greeted by members of the staff when they enter. Nursing unit secretaries make sure to visit patients’ rooms and introduce themselves so that the patients will know who they are calling when they have a question or concern. There are no visiting hours on Bridgeview; in fact, families are encouraged to stay at any time.
Amanda Schmitz and other patient care technicians now round with a purpose. “We ask pointed questions, such as are you in pain? instead of how are you today?” Schmitz explains. “We are learning to anticipate our patients’ needs.” And volunteer patient room ambassadors visit patients, bringing with them books, snacks and their full attention. Some may spend an hour just talking to one of the patients.
Physicians also are taking stake in this model. The unit is covered by hospitalists, who give a card with their name, photograph and contact information to patients when they are admitted. There also is a greater emphasis on physicians being present at discharge to offer instructions.
Afterwards, nurses use the “teachback” method, which gives patients an opportunity to absorb the information and ask questions so that they have the best possible outcome at home, notes hospitalist Alejandro Necochea.
The staff on Bridgeview is hoping to lead the way by example with this model of care. “The goal here isn’t to limit our successes to Bridgeview,” says Rand, “but to take the gems and use them across the Johns Hopkins Health System.”