Care delivery changes improve the admission process on 2 South

Brigham and Women’s Faulkner Hospital recently completed a major renovation project to the hospital’s inpatient psychiatric unit, 2 South. That project improves the physical space for both patients and staff. To coincide with the renovations, 2 South leadership enlisted the assistance of the Service Excellence and Performance Improvement Department to identify systems and processes that could improve efficiency. As a result, 2 South now has a new streamlined process for triaging and admitting patients from all Brigham Health sites to 2 South.

The work began with a meeting between 2 South staff and BWFH’s performance improvement experts to define the problem and explore current state. “We spent a full day session working with representation from every piece of the puzzle. We explored the role of the clinical liaison team, triage, nursing and the attending on both the BWFH and BWH side of things,” says Performance Improvement Manager Claire Massero. “We looked at the data and found that the average time it took to make a decision to admit a patient was 103 minutes and there were three separate decision-makers. Our goal that day was to think about the process a little bit differently and ask questions around who should be involved and what the process should look like to be more efficient.”

Massero explains the performance improvement (PI) process, “We went through several brainstorm exercises to identify barriers and explore solutions. We eventually got to a point where we could redesign and streamline the process. In the end, we identified one final decision-maker and we cut out at least half of the process steps.”

For the 2 South team involved in the PI process and who now use the new system, the experience has been very positive. “The performance improvement process was instrumental in our improvement efforts and really kept us on track,” says 2 South Clinical Leader Kerry Parsons, BSN, RN. “While looking at the current process, we realized there were multiple parties reviewing the same information. Because of the different disciplines, we were all looking for different information. Streamlining the questions asked and documentation in Epic has helped us pinpoint information more quickly in the clinical liaison consult note. Nursing is then able to look at available resources to accommodate the patient.”

Ensuring that patients can be safely cared for on the unit is a priority. Parsons explains, “The safety of the admitted patient population on 2 South is a very important factor and is always considered when making a decision on what additional patients can be accepted to the unit. This is especially important when taking a challenging patient that will require medical resources and an extra set of hands during their stay. The charge nurse is able to facilitate those resources before the patient arrives making their transition and ours a lot smoother. The goal is to accept patients to the unit and facilitate their arrival in a more timely manner, which so far has been working out great. Every nurse has been trained on how to review a patient so all of us are able to jump in when the charge nurse is off the floor or caring for another patient. One of the best things about improving this process is the ability to have a good plan of care for the patient before the patient arrives. While we’ve had some challenges, I think the process continues to improve every day.”

Paula Knotts, MSN, RN-BC, NE-BC, Director of Inpatient Psychiatric Nursing, and Dr. John Fromson, Chief of Psychiatry, who are the leaders of the unit, agree that the process change has had a positive impact. In fact, the average time it takes to make a decision to admit a patient is down from 103 minutes to 51 minutes. “The new process is a lot more efficient and involves a lot fewer people,” they say. “And hearing from the team, we feel confident that when issues do arise, the staff know that they can talk about it and work together to tweak the process further.”

*The improvement team also included many staff members from different disciplines throughout the Department of Psychiatry. We would like to acknowledge each of them for their hard work and contributions in making this a successful change. They include Drs. Sejal Shah, Naomi Schmelzer and Paul Schoenfeld, social workers Jennifer Karno and Megan O’Shea, Jessica Rosado and staff nurse Christopher Levesque.