A bright Saturday morning. Bagels. Donuts. Yogurt. Welcoming signs. Balloons.
Must be another moving day at University of Colorado Hospital.
All of the features listed above are standard-issue on days the hospital opens new units, with patients moving in, one by one, in a carefully choreographed sequence. On June 11, it was the Orthopedics Unit’s turn, with 13 patients moving out of the 22-bed 8 West wing of the Anschutz Inpatient Pavilion for a short trip across the bridge to a 36-bed unit on the eighth floor of AIP 2.
It was the last unoccupied floor in the tower, which opened in May and June of 2013. At that time, the eighth floor was one of four that were shelled and awaiting future volume growth.
The move started at 10 a.m. with a hip-replacement patient selected because of his “low clinical risk,” said Kelly McDevitt, RN, the unit’s nurse manager. McDevitt shuttled back and forth between the sending and receiving units and a command center in AIP 2 where a team coordinated the move and tracked and resolved issues.
“The command center says go,” said Dori Buese, RN, charge nurse for the Orthopedics Unit, who was the point person on the sending side. In AIP 2, Buese’s charge nurse colleague, Leslie Ward, RN, readied staff to receive the patient.
“Are you ready to make history?” a member of the sending team asked the patient. Minutes later, he was in his spotless new room in AIP 2. In the command center, team members made sure he showed up in the hospital’s bed tracking system and that his medical record was visible in Epic. Patient Services Director Jennifer Zwink, RN, wrote issues and their status on a white board as they arose.
The same routine continued throughout the day, with the last patient moving by 1:30 p.m. and the work wrapping up about 5:30 p.m., said Associate Chief Nursing Officer Cathy Ehrenfeucht, RN, MS. With that, the 8 West unit was closed. It will be “refreshed” by Facilities crews, with patching, painting and other work, and reopened later this summer.
The new unit is identical to other med/surg units in AIP 2, with three pods of 12 beds each, nine rooms equipped with ceiling lifts, and mobile lifting equipment available for the others, said Catherine Reeves, RN, manager of clinical planning and design. It also has space for a rehabilitation gym, which Reeves said should be ready in the next couple of weeks. The unit’s new home also includes patient conference rooms and video conferencing for consults with providers outside the hospital.
Providers will have more workstations and additional space for social workers, advanced practice nurses and residents, said Evalina Burger, MD, orthopedic surgeon at UCH and vice chair of the University of Colorado School of Medicine’s Department of Orthopedics. Burger noted that an office for social workers is especially important because roughly half of all orthopedic surgery patients have mobility problems and need placement with a skilled nursing facility or other post-operative services.
The move to a larger unit also sparked a hiring wave that began in February. Associate Nurse Manager Aurora Davis, RN, said the unit hired 20 new nurses, including six new grads, five CNAs and seven advanced care partners. Staff will now generally work one of three 12-bed pods for their shifts, with patients assigned on the basis of their acuity. But the pods are “part of a larger unit picture,” Davis said, and alarms in one unit will go off everywhere.
Burger said the unit timed the move for a relatively slow period but she expects the beds to be full by September “if not earlier.” The service will bring on two new physicians, specializing in foot and ankle and spine surgeries, respectively, in September, she added.
With the move, the hospital aims to accomplish in practice what it envisioned when it finalized its move to the Anschutz Medical Campus nine years ago this month: creating floors dedicated to specific service lines. The approach promised to make rounding more efficient and standardize the nursing care patients received.
“It was our intent when we came to the new campus to cohort our patients on the Orthopedics Unit,” McDevitt said. The hospital’s steady growth in patient volumes, however, scuttled those plans.
“Our volumes exploded beyond all original thoughts,” McDevitt said. With that, the most pressing issue became finding available beds for patients boarding in the Emergency Department or the Post-Anesthesia Care Unit. The Orthopedics Unit by necessity often became home for some non-ortho patients while non-ortho units became home for some ortho patients.
The extra beds made a dedicated inpatient unit a reality. Director of Orthopedics Michael Torpey, PT, said he anticipates important pay-offs from the move. For example, patients will receive consistent care and instruction from nurses with specific training in care for hip and knee replacements and other orthopedic procedures. That, in turn, promises to help providers manage length of stay and minimize post-discharge problems, Torpey said.
“It will be easier to make sure that what is being said to the patient is consistent,” he said, “and that we consistently set expectations for what happens next in their care.”
Meeting the standards
The benefits of a dedicated orthopedic unit aren’t theoretical, Burger said. She noted that a project led by orthopedic trauma surgeon Jason Stoneback, MD, McDevitt, and Mary Anderson, MD, dramatically cut average length of stay for geriatric hip fracture patients, in part by ensuring these patients were placed in the Orthopedics Unit, where they received specialized care.
On a dedicated unit, it’s easier for providers to get patients what they need with fewer delays, Burger said – everything from promptly delivering braces, crutches and wheelchairs to managing chronic bone infections to initiating early mobility. Yet before the opening of the new unit, up to half of orthopedic patients at any given time were in beds on different services. That was more than a matter of inconvenience for providers and patients, Burger added. Each patient move and hand-off between units increases the risk of error.
Patient safety and quality of care are paramount, but Burger also noted that health care payers are demanding improved efficiency and better patient outcomes. The Orthopedics service is in the middle of that effort. As of April 1, UCH began its participation in the Comprehensive Care for Joint Replacement Program, an initiative of the Centers for Medicare and Medicaid Services that aims to reduce readmission rates for patients who undergo total hip and knee replacement procedures. Hospitals are responsible for managing an entire 90-day “episode of care” with a “bundled payment” from CMS. That makes limiting length of stay safely and helping patients understand the steps necessary to a good recovery more important than ever, Burger said.
Getting the unit ready for all this to happen required extensive preparations. The UCHealth Board of Directors approved the $3.5 million budget for the opening at its Jan. 26 meeting and work began in earnest in February to install furniture, fixtures, IT services, phones, and other necessities, Reeves said.
Meanwhile, McDevitt’s team got staff ready for the move with “day in the life” training on the new unit. Michaela McCarthy, RN, PhD, said “super users” on the unit received expert training on lifts and safe patient handling, mock codes and resuscitation, and setup and care for patients in traction. The super users then provided required three-hour training sessions for nurses and nursing assistants, with physical and occupational therapists, the unit pharmacist and physician assistants also participating. In addition, Jack Oliver, coordinator of emergency preparedness and life safety, delivered emergency-response information. A total of about 100 people received training, McCarthy said.
Davis, who was a direct-care nurse during the Oncology Unit’s expansion to AIP 2 in 2013, said she’s emphasized to staff the benefits of the move to the new unit – larger nurse stations, more computers, better equipment for moving patients safely, and so on. One change seems likely to persuade even the most hardened skeptic.
“The new unit has seven bathrooms for staff,” Davis said the day before the move. “Right now we only have two.”