scholarly journals 144 The Use of a Multidisciplinary Team Discharge “Huddle” to Improve Patient Flow and Planning

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Mary Randles ◽  
Sylvia Hickey ◽  
Susanne Cotter ◽  
Carmel Walsh ◽  
Kieran O'Connor ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Multidisciplinary Team ◽  
Older Persons ◽  
Patient Flow ◽  
Geriatric Medicine ◽  
City Centre ◽  
Nurse Specialist ◽  
Complex Care ◽  
Clinical Nurse

Abstract Background Patient flow, the movement of patients is an integral part of the patient care pathway. With the goal of improving overall patient care and discharge planning, a hospital wide, multidisciplinary team based, patient discharge meeting or ‘HUDDLE’ was devised with the goal of facilitating onward care planning for all inpatients especially those with complex discharge needs in a city centre teaching hospital. Methods The patient flow huddle has evolved to include a Patient Flow Clinical Nurse Manager, Bed Manager, Medicine for Older Persons Clinical Nurse Specialist, Physiotherapist/Occupational Therapist, Consultant Geriatrician and Geriatric Medicine Registrar. Each team in the hospital are requested to attend at least twice a week. Predicted discharge dates are established. Teams discuss patients who have a requirement for rehabilitation, either short-term or complex rehabilitation and patients over 65 years who may need review from Older Persons Services .We sought to optimise issues including housing, home care packages, interim home supports, community intervention team referrals, integrated care and Nursing Home Support Scheme applications. Results There were 3918 Emergency Department presentations by adults over 75 in 2018 and 2113 admissions (3704, 2081 respectively in 2017). Accuracy for discharge within one day of PDD ranged from 52.5% (Jan) to 72.6 % (Nov). The average length of stay was 6.2days (SD 0.47). 172 patients (84 female, 88 male) were admitted for slow stream rehabilitation (median length of stay 30 days). Conclusion Rather than using a negative view of older adults as potential ‘bed blockers’, the discharge huddle allowed a pro-active approach to assist medical and surgical teams in the management and re-enablement of patients with complex care needs. Early identification of such patients with complex care and discharge needs allowed greater focus on appropriate planning earlier in the patient’s hospital journey.

Improving Family Communications at the End of Life: Implications for Length of Stay in the Intensive Care Unit and Resource Use

2003 ◽  
Vol 12 (4) ◽  
pp. 317-324 ◽  
Author(s):  
Tom Ahrens ◽  
Valerie Yancey ◽  
Marin Kollef
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
End Of Life ◽  
Resource Utilization ◽  
Intervention Group ◽  
Clinical Nurse Specialist ◽  
Control Group ◽  
Nurse Specialist ◽  
Clinical Nurse

• Background Inadequate communication persists between healthcare professionals and patients and patients’ families in intensive care units. Unwanted or ineffective treatments can occur when patients’ goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients’ outcomes and resource utilization.• Objectives To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit.• Methods During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician.• Results Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15 559 vs $24 080) and variable ($5087 vs $8035) costs.• Conclusions Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients’ families reduced lengths of stay and resource utilization.

Role of the Clinical Nurse Specialist in Improving Patient Outcomes After Cardiac Surgery

2015 ◽  
Vol 26 (1) ◽  
pp. 35-42
Author(s):  
Lisa M. Soltis
Keyword(s):  
Patient Safety ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Postoperative Period ◽  
Open Heart Surgery ◽  
Pulmonary Complications ◽  
Nurse Specialist ◽  
Early Extubation ◽  
Clinical Nurse

Health care reform continues to focus on improving patient outcomes while reducing costs. Clinical nurse specialists (CNSs) should facilitate this process to ensure that best practice standards are used and patient safety is enhanced. One example of ensuring best practices and patient safety is early extubation after open heart surgery, which is a critical component of fast track protocols that reduces may reduce the development of pulmonary complications in the postoperative period while decreasing overall length of stay in the hospital. This project was an interdisciplinary endeavor, led by the CNS and nurse manager, which combined early extubation protocols with enhanced rounding initiatives to help decrease overall length of ventilation time as well as reduce pulmonary complications in patients in the cardiac surgery intensive care unit. The project resulted in a significant decrease in length of stay and a decrease in pulmonary complications in the postoperative period.

The role of the urology clinical nurse specialist in the multidisciplinary team meeting

2011 ◽  
Vol 5 (2) ◽  
pp. 59-64 ◽  
Author(s):  
Benjamin W Lamb ◽  
Paula Allchorne ◽  
Nick Sevdalis ◽  
Charles Vincent ◽  
James SA Green
Keyword(s):  
Multidisciplinary Team ◽  
Clinical Nurse Specialist ◽  
Nurse Specialist ◽  
Multidisciplinary Team Meeting ◽  
Clinical Nurse ◽  
Team Meeting

The multidisciplinary approach to management

2012 ◽  
Keyword(s):  
Young People ◽  
Rheumatic Disease ◽  
Multidisciplinary Team ◽  
Multidisciplinary Approach ◽  
Transitional Care ◽  
Nurse Specialist ◽  
Clinical Nurse ◽  
Children And Young People ◽  
Holistic Management

The multidisciplinary team 378The role of the clinical nurse specialist 380The role of the physiotherapist 382The role of the occupational therapist 384The role of the podiatrist 385Transitional care 387• The experienced MDT is integral to the holistic management of children and young people with rheumatic disease with the patient and family at the centre (...

The tracheostomy clinical nurse specialist: an essential member of the multidisciplinary team

2014 ◽  
Vol 128 (2) ◽  
pp. 171-173 ◽  
Author(s):  
R Crosbie ◽  
J Cairney ◽  
N Calder
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidisciplinary Team ◽  
Clinical Nurse Specialist ◽  
Nurse Specialist ◽  
Intensive Care Unit Treatment ◽  
Common Procedure ◽  
Clinical Nurse ◽  
The Creation

AbstractBackground:Tracheostomies are a common procedure within the specialties of otolaryngology and intensive care. The ENT department at Monklands Hospital has developed the position of tracheostomy clinical nurse specialist to improve the management of tracheostomy patients. There is evidence to support the development of a multidisciplinary team for the management of tracheostomy patients following intensive care unit treatment; however, the creation of a specific tracheostomy clinical nurse specialist position has not been widely endorsed in the literature.Objective:This paper describes the role of the tracheostomy clinical nurse specialist, advocating this position within the multidisciplinary team.

The indirect patient care effect of a unit-based clinical nurse specialist on preventable pulmonary complications

1993 ◽  
Vol 2 (4) ◽  
pp. 331-338 ◽  
Author(s):  
SK Hanneman ◽  
AS Bines ◽  
WS Sajtar
Keyword(s):  
Patient Care ◽  
Pulmonary Complications ◽  
Clinical Nurse Specialist ◽  
Experimental Unit ◽  
Control Group ◽  
Nurse Specialist ◽  
Clinical Nurse ◽  
Control Units ◽  
Before And After ◽  
Estimated Risk

PURPOSE: To examine the indirect effect of a unit-based expert nurse on the incidence of preventable pulmonary complications, which were defined as malpositioned endotracheal tube and inadvertent extubation. DESIGN: A nonequivalent control group/separate samples pretest/posttest design was used to test differences in the incidence of preventable pulmonary complications before and after a 6-month intervention by a unit-based expert nurse in the experimental unit. Retrospective medical record audits were used to collect data on all consecutive admissions to the experimental and control units in March and April of years 1 and 2. RESULTS: Estimated risk ratios demonstrated a significant reduction in preventable pulmonary complications in the experimental unit after the test, even though the acuity was significantly higher in posttest patients. It was concluded that indirect patient care by a unit-based clinical nurse specialist can reduce the incidence of preventable pulmonary complications.

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