Happy staff? Satisfied patients? What’s going on here?

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Happy staff? Satisfied patients? What’s going on here?


Butch and Linda Stokes credit the Pasqua Hospital’s (PH’s) Medical Surveillance Unit (MSU) with saving Butch’s life.

Stokes was a patient on the unit for 11 days earlier this year after spending more than two weeks in hospital, getting progressively sicker with an unknown condition.

“I can’t say enough about the care,” said Linda. “The ball never got dropped. The care was consistent. Phenomenal. We were always included. Any questions we had, they were more than happy to answer. Dr. Kish Lyster had all the time in the world and the nurses were very informative, patient and kind. You rang the buzzer and they were there in five seconds. For us, it was a miracle.”

Although Butch says he no longer remembers his hospitalization, he was so impressed with his care at the time he wrote a glowing letter to Minister of Health Jim Reiter.

“Through my treatment, I witnessed the structure and efficiency of MSU and, in my opinion, (it) is undoubtedly the best in the Saskatchewan health (system),” he said in the Jan. 16, 2017 letter.

A different brew

What Stokes experienced was the unique care provided by our MSU.

The 12-bed unit is located on PH’s second floor. It opened January 8, 2016, to provide care for patients too sick for an inpatient unit, but not so sick they require intensive care.

“There are very few units like this across Canada,” said Marlee Cossette, who as unit manager co-leads the MSU with Lyster. “Some call them observation units or high acuity units.”

The unit is closed, which means only hospitalists can admit patients. Hospitalists are physicians whose primary focus is the general medical care of hospitalized patients. Lyster, Dr. Joanne McLeod and Dr. Lucas Potgieter have supported the unit from the beginning.  Lyster and McLeod previously worked on PH’s 4A, the province’s first Accountable Care Unit. When they came to the MSU, they brought this care model with them. Since that time, Dr. Evan Franko has joined the MSU, also coming from 4A. The province aims to have the Accountable Care Unit model implemented system wide by March 31, 2021.

Accountable Care Units have unit-based physician teams that include nurses, occupational and physical therapists, dietitians and social workers. Bedside rounds follow a specific structure, include multiple disciplines and occur daily at the patient’s bedside. The unit collects performance data on patient outcomes (e.g. falls, medication errors) so staff can improve care and the unit is co-managed by the nurse and physician.

“There are fewer missed signals with this system,” said Dr. Jason Stein in a telephone interview. Stein developed the Accountable Care Unit model. “Every care team member has vital information that they privately hold. When we put them together to share their information (through Structured Interdisciplinary Bedside Rounds) they make better decisions and provide better care.”

Balanced workload; growing patient numbers

Other processes that define the MSU are daily huddles, set criteria for admission, a warning system that helps identify when a patient’s condition is in the early stages of deterioration and an acuity tool.

Nurses use the acuity tool to score every patient each shift according to the complexity of the patients’ care needs and the level of resources required to meet these needs. This process helps staff continuously balance the workload across the team.

“It drives autonomy because staff has control of the assignments; it drives equity. You can come into this environment and know you’re getting the same workload volumes as your colleagues.”

Ensuring a balanced workload is essential, said Cossette, because the number of patients seen in the unit has steadily climbed.

“In 2015, we saw 320 patients. In 2016, we saw 655. We more than doubled the patient volume and saw sicker patients. We had the same staffing numbers and still had fantastic outcomes.” Outcomes that show safer, more satisfied patients and staff, and better allocation of funds.

The numbers tell the story

According to the data:

  • Patients are spending less time on the unit. The average stay from January 2015 to January 2016 dropped from eight days to 5.6.
  • Patients fall less. In 2016, patients experienced 14 falls, down two from 2015.
  • Patients experience fewer medication errors. In 2016, four occurred. In 2015, there were eight.
  • Patients complain less. From January 2015 to January 2016, complaints received by the regional patient advocate office shrank to one from eight. Concerns have been replaced with bouquets; the unit’s visibility wall is covered with cards and letters from satisfied patients.
  • Staff work less overtime. Between 2015 and 2016, over a nine-month period, overtime costs dropped 71 per cent – to 726 hours from about 2,500.
  • There are fewer staff injuries and they’re less serious. In 2016, eight staff were hurt on the job; four fewer than in 2015.
  • More staff have stayed. “In 2015, we hired 15 registered nurses (RNs) to replace those who left the unit for a variety of reasons. In 2016, we hired six,” said Cossette. About 35 nurses staff the unit – four at any given time.
  • Fewer new hires mean lower orientation costs. Nurse orientation tallied $78,000 in 2016, down from $185,000 in 2015. The cost to orient each nurse is between $13,000 and $16,000.

The net result of these improvements, said Cossette, is costs are down and morale is up.

“We saved just shy of $400,000 on a budget of just over $3 million. Dollars that would have been spent in 2015 were saved in 2016.

“We believe the decreased churn, decreased overtime and decreased sick time speaks to the overall health of the unit, to staff satisfaction.”

Wait? Change is good?

Rosella Gwilliam and Toni Tinio, RNs who work on the unit, agree.

“Initially, you’re nervous because this model is so different,” said Gwilliam. “You don’t know what to expect and how it will impact your work life, but it’s been amazing. The physicians are not only skillful and knowledgeable, they deal with people so beautifully it makes my job easier. It’s the best working environment in my 23 years of nursing.”

Tinio notes that having doctors dedicated to the unit results in happier patients and less frustrated staff.

“Patients are actually satisfied. They’re seeing their doctors and seeing the whole team come to their bedside to address their concerns. It puts everybody on the same page and reassures the patient and family.

“For staff, there’s more continuity. I’m able to do what I signed up for rather than being on the phone or frustrated. Things get done fast because the physician is around. You don’t have to start from Square 1.”

What’s next?

Cossette said as the new models of care have become established, she continues to be as busy as ever, but on different things.

“I no longer spend as much of my time filling jobs, tracking sick time, overtime and patient concerns. Now, I’m trying to invest in our staff through increasing their training and doing research to promote the work.”

She said next steps include continuing to improve how the unit functions by learning from similar units across the country and by further implementing remaining aspects of the Accountable Care Unit model. The team has made good progress, to date. For example, as of July, all of MSU’s physicians and registered nurses actively working on the unit have been certified in the Structured Interdisciplinary Bedside Rounds process, giving them the skills to lead the process at the bedside.

Cossette said that while, at times, “You feel as though you are taking on more water than you can bale off,” she feels privileged to co-lead the MSU. “Dr. Lyster and I could not be more proud of our team.”

Added Lyster, “Watching our team adapt and excel at this model of care is truly rewarding. We are immensely proud of the team’s accomplishments and how this model has helped our patients and families during their hospital stay.”