Game Plan 74/75

Know your game plan

In order to assure the coordination of care the physicians need to follow a set schedule. The schedule should be created by the physician team in close collaboration with the floor nurses. Once created all members of the team should follow the game plan so that the nurses can adjust their schedule to join each physician on rounds.  For more details see the individual playbooks. Predictability is critical for achieving coordinated teamwork.

7 DAYS PER WEEK (including weekends)

  • 7AM – 9AM  
    • Each hospitalist reviews the new laboratory on all patients using the EMR.
    • Sees all new admissions from the evening and night shifts
    • Completes paperwork and orders for patients to being discharged by 10 AM in coordination with the case manager and bedside nurse.
  • 9AM-9:15AM
    • Hospitalist meets in the Nursing Station with the case manager, charge nurse, nurse administrator and discharge tech  to review all disposition plans. When possible predict the discharges for the next AM to allow the nurse administrator to more accurately estimate available beds for the following AM bed control meeting.
  • 9:30 AM-11:00 AM Bedside Rounds with patient, hospitalist, and bedside nurse
    • Bedside rounds for all established patients (newly admitted and discharged patients seen before 9 AM) should include the patient and family (when available), hospitalist, bedside nurse, the charge nurse,(as needed when the bedside nurse unavailable), and when possible the case manager (particularly helpful for complex patients) and pharmacist.
    • Computer on rounds – WOWs are available for the doctors, in response to communication with the nurses and the patients new orders should be written at the bedside to assure accuracy and timeliness. (creating to lists is a form of batching and increases the risk of errors)
    • Average duration 6-10 minutes per patient. Be sure to review TEMP at the bedside (see specific playbooks for recommended communication template). By having a set schedule if the patient or family have too many questions or concerns the hospitalist can explain that he or she is scheduled to see other patients on the floor, but will return at 11 AM (after bedside rounds) to address additional concern
    • Write the plan for the day on the white board. This will assure that the patient and family know what the plan is for the day
    • The two hospitalists on 74 should start on opposites sides of the hallway as should the two hospitalists covering 75. The dual coverage hospitalist can start at the rear of the floor near the corner and work toward the front. (this approach minimizes the requirement for a bedside nurse to be at two places at once).

 

Ideal Hospitalist Interdisciplinary Rounds
Dr. Kiran Lukose, hospitalist at UF Shands, is conducting rounds at the bedside of Mr. Coon who has diabetic neuropathy, peripheral vascular disease and stepped on a nail resulting in infection of his toe. He is joined by bedside nurse Anesa Meadors and nurse clinical leader Tiffany LeGault. First Dr. Lukos updates the patient and nurses on the progress of Mr. Coon’s hospital care, followed by Nurse Meadors relaying key components of nursing care using the mnemonic TEMP – Tubes – IV lines, urinary catheter, E – eating, exercise, excretion, M – monitoring frequency including telemetry, vital signs, blood tests P – pain control and plan for the day. Dr. Lukose asks the patient if he has any questions and examines him. Finally Nurse LeGault writes the plans for the day on the whiteboard.

  • 11:00 AM – 3 PM  Clean up work and documentation
    • Write progress notes
    • Call consults
    • Problem solve
  • 3:00 PM- 3:15
    • Meet at the Nursing Station with the case manager, discharge tech, and charge nurse.
    • The charge nurse will remind the hospitalists and case managers by SPOK or text messagei
  • 3:15-End of the Day
    • Prepare discharges for the next morning
    • Finish up any incomplete tasks.

Ideal bedside Rounds Description by our Quality Specialist Jamie Gillium, RN: “I wanted to give you KUDOS on Multi-D rounding today. I rounded this morning with Dr. Bender and Elizabeth (CN) and they were fantastic. Elizabeth pulled the bedside RNs into rounds and they presented TEMP at the bedside in front of the patient. Elizabeth wrote the plan on the white board and the bedside RNs stayed there to hear the plan for the day and provide any additional feedback. Dr. Bender took the time to introduce the team to the patients upon entering the rooms, he sat/kneeled down on multiple occasions to make eye contact with the patients, he encouraged questions and empathized with the patients’ concerns. Dr. Bender used a computer while rounding and entered orders when needed. He was progressing the patients along, talking about expected d/c dates, discontinuing IVs and IVFs, etc. The unit was extremely busy today, as always, but honestly I am not sure rounds could have gone much better.”