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School of Medicine
Dome - A clockwork move
A clockwork move
Date: November 14, 2011
Transporting patients from the historic hospital to the new clinical buildings will be well choreographed and rehearsed.
In a simulated exercise, members of the patient move work group act out the roles that caregivers will assume in moving patients from the historic hospital to the new clinical buildings.
Two years in the planning, the patient move to the Sheikh Zayed Tower and Charlotte R. Bloomberg Children’s Center will be a carefully orchestrated operation that leaves nothing to chance. The two-day process begins at 7 a.m. on Sunday, April 29, with the pediatric and adult emergency departments, and it concludes at approximately 6:30 p.m. on Monday, April 30, when pediatric psychiatry patients arrive on their new unit.
Given the move’s complexity and dependence on interdisciplinary cooperation, it was tricky at first to imagine how it would come together, says Dawn Luzetsky, assistant director of nursing in the Children’s Center. “It was difficult to visualize how we were going to get everyone on board,” says Luzetsky, who led the patient move work group’s transport team task force.
Slowly but surely, Luzetsky and all work group members realized that there was only one way to devise a safe and efficient plan for moving patients. “We all had to come together and follow the same process,” Luzetsky says. “Each unit was a cog in the wheel and if a cog loosened up or somebody didn’t do their job, the wheel would fall off.”
Working closely with outside consultants who specialize in transition management, a group composed of administrators, clinicians and support staff across The Johns Hopkins Hospital has mapped out an exhaustive plan based on time studies, projected patient population, move exercises, countless spread sheets and revised checklists.
At the center of the plan are the nurse managers, patient coordinators and charge nurses in each unit who will be assembled into three teams for sending, transporting and receiving patients. During the move, respiratory therapists may accompany the transport team, depending on a patient’s acuity. Closer to moving day, managers will identify team members and the roles they will play in the move.
Following step-by-step instructions for each phase of the move, team members will hold pre-move “huddles,” prepare patients for the move, approve papers dubbed by the team as “Ticket to Ride” certificates, and escort patients to the new buildings while monitoring vital signs and getting them settled on their new units. Numerous patients will be moved by way of connecting passages between Wilmer, Nelson and the new buildings. On the sending and receiving sides of the move, support staff will make sure the rooms are clean, provide meals and run errands as needed.
From a command center in the new clinical buildings, managers will authorize and supervise the move, keep the activity on a timetable and stand poised to handle any problems. It’s estimated that it will take 10 to 12 minutes to move an individual patient. Lead coordinators on the sending and receiving side of each unit will confirm when a patient has been safely relocated, and will convene a post-move huddle for members of all three teams.
Calculations for reducing the patient census leading up to the move will help to simplify the process. Preparations will begin one week before the move, when caregivers will tell patients and families what to expect. Other tasks, such as cleaning out old charts and confirming that patients have ID bands will unfold leading up to the move.
All patients will be moved in their beds with the exception of those in pediatric psychiatry, who will walk in a group to their new unit. The work group has also collaborated with patient and family advisory groups to ensure their support during the move. One family member will be allowed to accompany each patient. Others will be invited to gather in a designated area of the historic hospital, where they can sip coffee and wait to see loved ones.
Provisions for infection control, moving unstable patients, transporting controlled medications and relocating emergency room patients are among many considerations still in the fine-tuning stage. Mock patient moves are planned for Feb. 12 and March 16. A time study using different connections between the historic and new buildings will take place on Dec. 16.
A patient move manual for Hopkins Hospital staff is in preparation. In the meantime, you can link to a demonstration of the “patient move game,” which simulates the real move, on the Inside Hopkins intranet site.