179 Background: Increased emphases have been placed on hospital safety, and patient and nurse satisfaction in the competitive cancer care arena. The current climate demands critical attention to stakeholder input in cancer care delivery. Methods: Stakeholder (patients, families, nurses, physicians, and other members of the multidisciplinary care team) input directed efforts in an adult/pediatric oncology/hematology unit renovation. A true focus on stakeholder involvement was evident by uniting the patient advisory council from the cancer care service line, multidisciplinary staff, and unit-based shared governance structures to form the design team. Uniting multiple perspectives and eliciting design team ideas and recommendations ensured renovation plans remained focused on improved care delivery and processes. The design team discussed all aspects of renovation, including work flow, equipment/technology needs, safety and security, and family/child friendly spaces. A key feature of the renovation was the universal room concept, which meant that rooms needed to be adaptable to a cancer patient’s changing needs: from standard care to critical care. Stakeholder input was sought on as all aspects progressed as final decisions were made on aesthetics, family-focused amenities, work flow structures such as location of equipment and supplies, and patient safety features (especially in bathroom spaces). Results: Total falls decreased from 6.17 to 3.1 per 1,000/pt days and falls with injury decreased from 2.9 to 1.8 per 1,000/pt days. Improvements in patient satisfaction scores were seen in “overall room” scores increasing from 79.9 to 90.5 and “visitor /family” satisfaction increased from 87.9 to 92.1. Overall nursing satisfaction improved from 56.68 to 64.58 and job plans to remain on unit rose from 63-89. Conclusions: Avoiding a top-down, hierarchical decision-making process from conceptualization to realization resulted in measurable changes in patient safety and patient and staff satisfaction from pre- to post-renovation. This process can utilized to address the changing needs in cancer care.
Identifying safe care processes when GPs work in or alongside emergency departments: realist evaluation
