By designing a more thoughtful pattern for its staffing assignments, Emory University Hospital (EUH) overcame unit “geography” obstacles with their innovative care zones model. Shockingly, the model cost nothing to implement and they report it has improved their patient outcomes and nurse workflow.
In 2014, EUH’s 24-bed general medicine unit was experiencing high call-light volume and low patient satisfaction. The unit also fielded increased nurse workflow complaints and experienced excessive incremental overtime. More importantly, the unit’s spread-out, U-shaped configuration increased the distance nurses traveled between their patients, which led to a rash of patient falls.
In fact, by the beginning of 2015, they had reported six consecutive quarters of patient fall data in the red zone — about five or six per month — on the unit nursing quality index.
The tipping point came when two patients on opposite corners of the unit each fell within moments of each other. Both patients were assigned to a veteran nurse who hadn’t had a single patient fall in his six-year career.
“That was a perfect illustration of the unit’s geography problem,” recalls unit charge nurse William Bodnar.
The unit’s inefficient layout led to more than patient falls. EUH Specialty Director Greg Kingsley-Mota, MSN, RN, NEA-BC, who was unit director at the time, identified multiple challenges for nurses, patients and staffing budgets, including:
- High call-light volume
- Ineffective handoffs
- Increased incremental overtime
- Lower patient and family satisfaction
- Nurse dissatisfaction with workflow and assignments
- Long distances between assigned patients
EUH, which originally had an inflexible pod system, then implemented the AACN Synergy Model. But with no standardized acuity tool or system, the model alone wasn’t effective, and the pod morphed into subjective assignments that crisscrossed from one end of the unit to another. The staff often felt assignments were unfair. The general consensus: There’s a problem with the acuity system.
“I had nurses in my office in tears because they felt we had not set them up for success because of the way they were assigned,” Kingsley-Mota says. “Individual clinicians felt like they were being targeted or penalized for having more in-depth skills. They were worn out. Meanwhile, others were perceived as getting lighter assignments.”
He realized that too much depended on the clinician’s level of experience and length of time in practice. Varying feedback from multiple nurses on patient acuity was driving how the charge nurses made nurse-patient assignments.
The EUH team found parallels in the research literature from similar university health systems, but nothing matched perfectly. Their front-line clinicians needed scheduling flexibility and fluidness to adapt to patient flow. The team envisioned that a new system must stay as equitable as possible throughout a 12-hour shift, account for existing resources and keep a commitment to the AACN Synergy Model of matching nurse competencies with patient needs.
For EUH, it was time to get creative and innovate.