Transforming Care and Cost
at the Bedside
Jennifer Fogel, RN
Director of Nursing Systems
Eastern Maine Medical Center
TCAB Goals
• Improve the quality and safety of patient
care
• Increase the vitality and retention of nurses
• Engage patients and families and improve
their patient care experience
• Improve the effectiveness of the entire care
team.
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The Bonus!!
• Cost Savings
• Cost Avoidance
• Lower Healthcare Costs
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Example 1: Nurse Servers
Aim Statement
To increase time at the bedside by
bringing frequently used supplies closer to
the bedside.
Grant 6 TCAB Innovation
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Nurse Servers – The Plan
Organize the “Nurse Servers” (closets)
outside each patient room with frequently
used supplies and patient signs
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Time Savings = Cost Savings
• Each Nurse saved 4318 steps/week equaling 88
miles per year
This Equates to
•
•
•
•
43 minutes/week
37 hours per nurse/year
$1,295/nurse/year
Total Cost Savings on Grant 6 $14,245.00/year
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Example 2: Medication Safety Zone
Aim Statement
To decrease the number of interruptions
during the medication preparation
process.
Grant 6 TCAB Innovation
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Medication Safety Zone – The Plan
A red box will be placed around each Pyxis
medication station. No one will speak to or
interrupt the nurse when standing inside the
safety zone.
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Interruptions = Cost Avoidance
• While only one piece in the battle against
Medication Errors, following implementation,
Medication Errors fell 37%
• Medication errors can increase length of
stay by 8 to 12 days or costs $16,000 to
$24,000 (IHI)
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Example 3: 4-Eyed Assessment
Aim Statement
To increase the accuracy of skin
assessments completed on high acuity,
high risk patients.
Grant 6 TCAB Innovation
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4-Eyed Assessment– The Plan
2 RN’s will:
1. Complete a head to toe skin assessment on:
– All transfers from Critical Care and outlying facilities
– High Risk Patients admitted from home (i.e. limited
mobility
2. Discuss and collaboratively document any skin issues
3. Immediately implement pressure ulcer prevention
interventions
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Accuracy = Cost Avoidance
• Since implementation Grant 6 reached 330
days and are currently at 223 days without
a pressure ulcer. (One pressure ulcer broke their
streak)
• This equates to a cost avoidance from
between $2,000 and $40,000 per pressure
ulcer (medscape.com)
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Example 4: Red Box
Aim Statement
Improve patient and staff satisfaction
while saving time (time of putting on and
removing gloves and gowns) and money
(cost of the gloves and gowns)
Cardiac Telemetry
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Red Box – The Plan
1. A three foot box will be created inside
each room using Red Tape.
2. The Red Tape will removed with each
patient discharge.
3. Forms will be posted outside each room
for staff to mark if they had to wear PPE
or not with each patient encounter
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Red Box – The Plan
1. A three foot box will be created inside
each room using Red Tape.
2. The Red Tape will removed with each
patient discharge.
3. Forms will be posted outside each room
for staff to mark if they had to wear PPE
or not with each patient encounter
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Satisfaction = Cost Savings
• Note: These cost savings are for a 30 day
trial using the 4 precaution rooms.
• Using the average time to don and remove
PPE of 70 seconds – 5.86 hours were
saved
• The cost of gowns and gloves x the number
of times PPE was not used = $157.50
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Remember:
• Staff driven innovations not only improve the
quality and safety of patient care. They also
decrease costs.
So…
• When creating metrics consider using the
financial benefit as one of your measures. It is a
great way to show additional value and your CFO
will become your biggest supporter!
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Questions?
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