Hospital for Special Surgery
Hospital for Special Surgery (HSS), the number one nationally ranked orthopedic hospital, and a Magnet Designated Hospital, has identified a need to offer further nurse-driven community outreach programs. HSS requested a Capstone team to help incorporate evidenced-based best practices into their nurse-driven community outreach education program. The team was asked to develop a program that can be implemented and translated to other populations, to develop an assessment tool to evaluate success of the program, and to identify the costs and resources needed. A literature review was conducted to research current best practices. The team recommended compiling two databases: one for community centers accessed, and one for public outreach resources. An evidenced-based evaluation tool will provide the HSS Nursing Department with a formal nurse-driven education program and an avenue for their nurses to put into practice their teaching skills.
Review of Current Hourly Rounding Nursing Processes at New York Presbyterian Hospital
New York-Presbyterian Hospital (Hourly Rounding)
Hourly nurse rounding is an eight-step, scripted, proactive approach to patient care. Studies have shown that the practice of hourly rounding can improve patient satisfaction and safety, particularly in the reduction of falls in hospitals. Increased job satisfaction and decreased workload have also been reported on inpatient floors where hourly rounding has effectively been implemented. In an effort to increase compliance to hourly rounding, the Capstone team reviewed the current nursing processes for hourly rounding on several in-patient units. Based on outcomes data, the team chose higher and lower performing units. In addition, they completed nursing observations on four floors as well as focus group and patient care director interviews on six floors. An analysis of the data yielded the following recommendations: the need for shared decision-making and accountability in the implementation of the process, which includes a well-designed communication plan and the need to define and simplify hourly rounding, focusing on the key steps.
Organ Donation Beliefs and Attitudes
New York-Presbyterian Hospital (Organ Donation)
More than 11,000 people need life-saving organ transplants in the United States. On average, 18 people die every day because of the shortage of organ donors. In New York, organ donors both deceased and living are on a decline while the number of patients requiring transplants is steadily growing. Through Joint Commission initiatives that require all hospitals to provide staff education about organ donation, New York Presbyterian (NYP) has the potential to make a difference by educating physicians, nurses, and other direct-patient care providers about enrollment in the New York Donate Life Registry. The team surveyed a select group of nurses, physicians, and ancillary staff employed at selected ICU’s, Emergency Departments, Operating Rooms, and medical-surgical units at the various NYP campuses in order to better understand attitudes and beliefs relating to organ donation, the factors that influence their positions, and any myths or misconceptions that may exist. Recommendations were made to assist in the development of custom educational programs regarding Organ Donation for all employees at NYP.
Length of Stay and Early Mobilization of ICU patients
New York-Presbyterian Hospital (Length of Stay)
As part of the mission to deliver the highest quality, safest and most compassionate care, the New York Presbyterian HERCULES or Hospital Efficiency, Revenue Cycle, Clinical Utilization, Length of Stay (LOS), and Enhanced Sourcing initiative has identified opportunities to improve patient outcomes while reducing costs. A primary focus to reduce the LOS centered on early mobilization of the ICU patient. The Capstone LOS team assessed characteristics conducive to successful implementation of an early mobilization program. A retrospective chart review of specific metrics on sedation, pain, activity levels, and physical therapy was conducted on charts from six ICU's inclusive of the Cornell and Columbia campuses. In addition, focus groups were conducted in these ICU's using a multi-disciplinary approach to assess perceived barriers to early mobilization. Physician, Nursing, Respiratory Therapy, and Physical/Occupational Therapy front line staff contributed to the discussion. The results of the analysis provided a recommendation for a model unit with the best opportunity for success to reduce the LOS through early mobilization. This will enhance the second stage roll-out in the ICUs not initially included in the original intervention.
Improving the Discharge Process for Short Stay Surgical Urology Patients
New York-Presbyterian Hospital (Short Stay)
The Baker 15 unit at New York Presbyterian (NYP) is a short-stay surgical unit with an expected length of stay of less than 48 hours. The Capstone team focused on the surgical urological patients who make up more than 65 percent of the discharges. The objective for this project was to decrease the length of stay, streamline the discharge process, and increase patient readiness for discharge. The Capstone team observed and interviewed patients and care providers from diagnoses to discharge. Areas for improvement were identified in pre-operative education, the need for standardization of post-operative supplies, and the underutilization of nurse practitioners managing discharge care. Best practice research identified cutting edge discharge methods including virtual online education sessions, instructional videos, and visual fact cards. Best practice hospitals use nurse practitioners to manage the patient post-operatively, which has proven to lower length of stay. The team recommended that NYP implement best practice methods in order to make the discharge process more efficient for care providers, increase patient confidence for discharge, and decrease length of stay.