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February 12, 2016

What you'll find on Barnes-Jewish Hospital's 11th floor: a testing ground for the entire health system

Daily Briefing

    Barnes-Jewish Hospital is using its new neuroscience unit as a testing ground for the entire BJC HealthCare system's approach to delivering higher-value care, Samantha Liss writes for the St. Louis Post-Dispatch.

    As Medicare and other payers tie more payments to outcomes such as readmissions and hospital-acquired conditions, hospitals across the country are "looking for ways to innovate their work to ensure that the care they deliver is high quality and efficient," Chas Roades, chief research officer for health care at The Advisory Board Company, tells the Post-Dispatch.

    For Barnes-Jewish, that meant launching several pilot projects when it opened its 21-bed neuroscience unit last month on the hospital's 11th floor. Hospital leaders are calling it the "innovation unit."

    Promoting teamwork and problem solving

    To lead the way in identifying efficiencies and reducing complications, the neuroscience unit needs the right team members. That's why it has distinct hiring practices, interviewing candidates with an eye toward their ability to be transformative leaders and "think outside of the box," according to a BJC HealthCare blog post.

    All team members also go through training to learn not only their roles "but the roles of each person on the unit—occupational therapy, physical therapy, speech, patient care technicians, unit secretaries, dietitians, everyone," says veteran Barnes-Jewish nurse Elizabeth Perry. The goal is to cut down on communication barriers and encourage teamwork, adds Julie Griffin, director of patient care services for neurosciences.

    Engaging patients in the care

    The unit has a unique staffing arrangement to promote evidence-based practice and improve outcomes. It's the hospital's only neuroscience division with a clinical nurse specialist, who focuses on instilling evidence-based practice, and a nurse educator, who works to educate staff, patients, and family members on such practices.

    In addition, a lead charge nurse is on the unit's floor 24 hours a day to work with patients and their family members from the moment they arrive and to break through barriers that could hold back their recovery.

    Cutting down on readmissions

    With an eye toward reducing readmissions, the unit also implemented a new protocol on educating patients in advance of certain surgeries. In the past, patients received educational material after their surgery, when they may have been in pain or disoriented, making it difficult for them to retain the information.

    Now, nurses in the unit meet with patients before surgery, provide them with a booklet detailing what to expect—including their estimated recovery time—and answer their questions.

    "I think people learn better when they're not anxious," says Jacqueline Helm, a nurse on the unit. And that increased knowledge, the unit hopes, will keep patients on top of their recovery and out of the hospital.

    Other departments joining in

    The neuroscience unit is just one of several at Barnes-Jewish that's testing out new ideas to improve care.

    For instance, nurses in another unit implemented a new protocol to help critically ill patients move sooner and more often, since lying in a hospital bed without much movement can make patients weak and susceptible to further complications.

    By increasing the amount of time these patients moved, the hospital reduced the average length of stay by a day, prompting other hospital departments to consider implementing the practice (Liss, St. Louis Post-Dispatch, 2/7; Lodge, BJC Today, 1/11).

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