Getting Different Results: Patient Care Facilitator Role

1. Getting Different Results: Patient Care Facilitator Role Insanity: doing the same thing over and over again and expecting different results. ~ Albert Einstein~

2. RN practice: 2006 • Average task time 3.1 minutes • Interrupted mid-task 8 times per shift • 31-44% of time on direct care • 34-49% on coordination-related activities Tucker, A., Spear, S. Operational Interruption in Hospital Nursing. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC1713207Accessed October 7, 2011.

3. Shorter Inpatient Stays Environmental Srv Speech Therapy Decreasing Reimbursement Acuity Resp.Therapist PT/OT Central Supply Residents Nursing Students Bio Med Clinical Nurse Specialist I.T. Consulting Dr. Attending RN Transport Laboratory Radiology RN Care manager Consulting Dr. Dietician Plant Ops Consulting Dr. Patient Access Pharmacist Anesthesiologist Blood Bank H.I.M Cath Lab EKG Chaplain Nuclear Medicine Diagnostic Srv Med Students Host/Hostess C.N.A Clinical Trials Technology

4. RN: Plan for the DAY • Most similar to current staff nurse role • Bedside cares, treatments, caring moment • Reports to Nurse Manager • RN: Plan for the STAY • Coordinate, facilitate & oversee patient’s care • Enhance team communication • Consistent face to patient • Reports to Nurse Manager.

5. High Expectations • 3 years recent acute care experience • BSN • MSN must be obtained in defined timeline • Certification to be obtained if not current • Great collaborator and communicator

6. Patient Care Facilitator • Patient Care & Advocacy • Navigator • Patient Education • Transition education and readiness • Post discharge phone calls • Educate patient/family re: options • Interdisciplinary Team Leader • Coordinate plan of care for patient stay. • Transition plan (discharge) • Round with physicians • Lead interdisciplinary rounds • Outcomes Manager • Risk assessment & reduction • Monitor and trend outcomes measures • Readmission data • Implement strategies to improve outcomes • ProfessionalPractice • Expert practitioner • Implements evidence based practices • Leadership • Staff education • Provide input into performance evaluation • Regulatory compliance • Supervises nursing practice • Change agent and mentor to frontline caregivers • Plan of care • Monitor & assure progressing toward readiness for next LOC • Arrangements for next LOC if needed • Keep patient/family involved in plan of care. • Educate care givers on plan of care • Strategize to reduce LOS

7. Patient Care & Advocacy • Navigator • Patient Education • Transition education and readiness • Post discharge phone calls • Educate patient and family regarding options

8. Outcomes Manager • Risk assessment & reduction • Monitor and trend outcomes measures • Readmission data • Implement strategies to improve outcomes

9. Plan of care • Monitor & assure progressing toward readiness for next level of care • Arrangements for next level of care if needed • Keep patient and family involved in plan of care. • Educate care givers on plan of care • Strategize to reduce length of stay

10. Interdisciplinary Team Leader • Coordinate plan of care for patient stay. • Transition plan (discharge) • Round with Physicians • Lead interdisciplinary rounds

11. ProfessionalPractice • Expert practitioner • Implements evidence based practices

12. Leadership • Staff education • Provide input into performance evaluation • Regulatory compliance • Supervises nursing practice • Change agent and mentor to frontline caregivers

13. Physician Perspective

14. Shorter Inpatient Stays Speech Therapy Environmental Srv Transport PT/OT Resp.Therapist Central Supply Clinical Nurse Specialist Patient Access Residents Nursing Students Bio Med Care manager Attending I.T. Laboratory Acuity Social Worker Decreasing Reimbursement Multiple consults Radiology Dietician Plant Ops Host/Hostess Chaplain Blood Bank H.I.M Pharmacist EKG Anesthesiologist Diagnostic Srv Med Students Nuclear Medicine Cath Lab Clinical Trials Technology

15. Outcomes Readmission

16. Length of Stay Primary Hip & Knee Replacement Implemented PCF role 11/2009

17. MWH Inpatient HCAHPS

19. “Good care coordination will be the key to success with ACO’s” Dr. Mark Purtle, MD, VPMA, IHDM

20. Insert photo of employee is lobby Thank you!