It all started with an idea for change that spurred an important decision among five inquisitive residents.
Emily Leasure, MD, medical director for 7 Northwest at UC Health University Hospital, says a small survey was conducted with six patients scheduled for discharge from the hospital to find out their view of care in the hospital and to see what they learned about their diagnosis/illness during their stay.
The results left a lasting impression on Leasure.
"The only feeling one patient took away was that her doctors were solely concerned with her dialysis, not with her breathing difficulties, which was the problem that brought her into the hospital,” she says, adding that after speaking with the team and reviewing the patient’s chart, she found that the patient had been diagnosed with chronic obstructive pulmonary disease (COPD).
"She was leaving with the thought that nothing was done for her symptoms, unaware that she was prescribed prednisone and antibiotics for her COPD flare. She wasn’t planning to fill the prescriptions for several weeks because she didn’t have the money, and she didn’t fully understand what purpose the medications served,” Leasure continues.
"She was angry and unsatisfied with her care, and as I tried to explain that those medications were crucial for her wellness, she simply said, ‘Oh, that’s just life. You gotta figure it out, which I do.’
"If we were just able to explain everything to her in a better way, she would have been happier and healthier, and now, she’ll likely never come back to receive her care at University Hospital.”
With this eye-opening experience under her belt, Leasure is now serving as the leader for Project RENEW—an initiative developed by Eric Warm, MD, program director for internal medicine and the internal medicine residency program at UC.
Project RENEW (REvitalizing the patieNt Experience on the Wards), which began this month, will incorporate geographic teaming of internal medicine residents, patient-centered bedside rounds, daily checklists and team-specific quality outcome measurements in a reorganization of the hospital’s care model.
"We’ll be changing the culture of our medicine service to a team-based, patient-centered and patient/physician accountable ap-proach,” says Warm. "We want to make sure that the patient is at the center of our focus.”
As part of RENEW, residents will be assigned to teams according to their location in the hospital. Each team will have an additional pager assigned which will be carried by the on-call resident, making the team more easily accessible at any given time of day.
Leasure says this grouping will be more efficient for residents, who will handle all patients in one area of the hospital as opposed to being spread throughout, providing a more unified effort in patient care.
In addition, these care teams will be conducting bedside rounds which involve physicians, nurses, case managers and other health care providers holding open discussions about the patient’s care directly in front of the patient.
"Rounding at bedside allows the patient to have a say in his or her own care,” she says. "It also eliminates confusion and ensures that the patient is aware of treatments being administered to him or her.”
Leasure adds that one comprehensive checklist is also being developed to standardize communications between the patient and care team members.
Warm says accountability will also be measured via data collected from surveys.
"We will be keeping track of and analyzing patient satisfaction, referring physician satisfaction, and a social network analysis, looking at how all of the people in our team communicate with each other and with the patient,” he says. "These numbers will tell us if what we think is working truly is.”
Leasure says it’s her hope that with all of these components in place, Project RENEW will create the system she’s been dreaming about since residency.
"We’ve been putting patches over a problem and have come to the realization that we need to revamp our program on a larger level,” she says. "This system change will help in delivering the best care possible and making patients believe that University Hospital is where they want to be.”