Oh, the Places You Will Go With Your Dynamic Duos

Project Topic:

Improving the perception of inadequate staffing and increasing morale by collaborating across units to create a buddy system, creating efficiency, and leaving no team member alone

Hospital, City and State:

ChristianaCare- Wilmington Hospital, Wilmington, Delaware

Unit:

6South-Transitional Care and Intensive Care Units

CSI Participants:

• Colin Durham, ADN, RN, CCRN
• Anne Schu, BSN, RN
• Jennifer Sullivan, BSN, RN, CCRN
• Nallely Zavala, BSN, RN, PCCN

Project Goals/Objectives:

1. Increase Healthy Work Environment Assessment Tool (HWEAT) scores for Appropriate Staffing and True Collaboration in both units 0.5 points
2. Increase patient mobility from 61.7% to 75%
3. Decrease the length of stay 0.5 days
4. Decrease ventilator days 10%

Project Outcomes:

1. Increased HWEAT score for Appropriate Staffing in TCU from 3.59 to 3.61
2. Increased HWEAT score for True Collaboration in ICU from 3.82 to 3.89
3. Increased HWEAT aggregate score in ICU from 4.13 to 4.22
4. Increased all HWEAT standard scores in ICU except skilled communication which remained the same
5. Decreased hospital length of stay (LOS) for TCU 0.3 days
6. Increased the John Hopkins Highest Level of Mobility (JH-HLM) 2 daily goal achievement in TCU from 61.7% to 75%
7. Increased ventilator days in ICU 75 days
8. These outcomes resulted in a positive estimated annual fiscal impact of $1,735,493

Project Overview:

Staff morale and burnout were the reasons for initiating change in the two units. Staff repeatedly acknowledged they were tired, and some could not describe their feelings. Long and busy days added to this frustration. Other initiatives helped a bit, but there was still something missing.

The CSI team administered the HWEAT to staff in both units. The initial findings showed True Collaboration and Appropriate Staffing as the opportunities for both units. Through much conversation and evaluations of current and previous practices, the CSI team decided to implement a Buddy System. Each day, nurses and techs are paired with another nurse or tech to help make the day smoother and to get the work done. They are encouraged to check in on one another throughout the day and pair up for patient turns, mobilizing patients, covering lunches, and being present.

The unit staff were ambivalent at the start, but after a short time, they were calling out for their buddies. When the project began, we noted staffing concerns that were worse than previously. The CSI team pivoted to ensure that float nurses understood the Buddy system. We made the project work by being intentional each day as we worked with the assistance of our team, leadership, and our champions.

Over the seven months, we did not improve some metrics that we thought would be positively affected: mobility for ICU and TCU. We continue to focus on this as we work within our Buddy System. We did meet a big goal of decreasing hospital LOS for TCU by 0.5 days and ventilator-associated events in the ICU by 2. We are proud of this and our current positive trajectory.