In December, Ann Arbor-based University of Michigan Health System moved patients to its new $754 million C.S. Mott Children's and Von Voigtlander Women's Hospital. The new hospital is 1.1 million square feet, compared with the previous hospital's 267,000 square feet. In addition, the new hospital has all private patient rooms, while the original facility had shared patient rooms. These changes required clinicians and staff to adjust their workflows to be efficient in the new environment.
Gaining situational awareness
For nurses in the newborn intensive care unit, who were used to working in a large room with up to 10 infants, moving to single-patient rooms was a significant change. One of the goals for nurses in the new Children's and Women's Hospital was to gain situational awareness in a facility that was more than four times the size of the previous building. UMHS needed its nurses to remain as connected with their patients as they were in the old building. Previously, the unit was one large room, so nurses needed a strategy to ensure quick access to patients and other caregivers in the new environment. The nurses integrated technology into their daily workflows to stay up-to-date with patients' conditions. UMHS partnered with Connexall to route all patients' alarms from nurse call and monitors to mobile devices nurses carry during their shift.
Understanding workflow
Before implementing the new system, the nurses had to go through processes step-by-step to evaluate their workflow and determine how the technology could be used to improve their processes. Although the nurses were familiar with their own workflows, it was important to break it down by steps to clearly identify any potential breakdowns and opportunities for the technology to be used. "Assume nothing when you go in," says Kathrynn Thompson BSN, RN, interim nursing operations administrator at UMHS. "Treat everything new so you can get down to what the workflow issues are and advocate and plan for the future state."
The workflow teams took a systemic approach to the workflows so the nurses could see how individual processes interact, according to Craig Martin, senior business analyst at UMHS. By conducting mock scenarios of different events, the nurses could become familiar with the technology and with each person's responsibilities for responding to secondary alerts.
In addition to the nurses practicing new workflows, IT staff shadowed nurses to learn about their workflows and gain a better understanding of how the technology could aid nurses in delivering care. "It was critical that all the people working on our project who were from IT understood what it was like — the environment, the demands and the various types of existing communication methods they utilize on a daily basis," Mr. Martin says.
Collaborating as a team
Bringing individuals from across the organization together to work on this project was crucial for its success, according to Christine Szumko, IT activation manager at UMHS. She suggests collaborating with people from different backgrounds, such as biomedical engineering and nursing informatics, in addition to inpatient and emergency department nursing units, and IT. "You need to have a cross-functional team working together," she says. "You have to develop people who can speak across multiple disciplines." For example, the core implementation team — which Mr. Martin, Ms. Szumko and Ms. Thompson were part of — had two activation nurses participate in the majority of some IT meetings to learn more about the technology's application to their workflow. "Our team became very skilled in communicating across traditional hierarchies," Ms. Szumko says.
Implementing new technology
The activation nurses who were part of the core implementation team were trained to be supertrainers to help nurses in their unit integrate the new technology into their workflow. For five weeks the supertrainers and an IT support team worked with the units to perfect the system. To date, the technology has been implemented in three pediatric and newborn ICUs, six general care areas, a pediatric emergency room and a women's birth unit. The new system allows nurses to continue to monitor patients while they are out of the room and call on colleagues quickly to resolve any issues. "The nurses feel connected to what's going on in the patient's room," Ms. Thompson says.
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Gaining situational awareness
For nurses in the newborn intensive care unit, who were used to working in a large room with up to 10 infants, moving to single-patient rooms was a significant change. One of the goals for nurses in the new Children's and Women's Hospital was to gain situational awareness in a facility that was more than four times the size of the previous building. UMHS needed its nurses to remain as connected with their patients as they were in the old building. Previously, the unit was one large room, so nurses needed a strategy to ensure quick access to patients and other caregivers in the new environment. The nurses integrated technology into their daily workflows to stay up-to-date with patients' conditions. UMHS partnered with Connexall to route all patients' alarms from nurse call and monitors to mobile devices nurses carry during their shift.
Understanding workflow
Before implementing the new system, the nurses had to go through processes step-by-step to evaluate their workflow and determine how the technology could be used to improve their processes. Although the nurses were familiar with their own workflows, it was important to break it down by steps to clearly identify any potential breakdowns and opportunities for the technology to be used. "Assume nothing when you go in," says Kathrynn Thompson BSN, RN, interim nursing operations administrator at UMHS. "Treat everything new so you can get down to what the workflow issues are and advocate and plan for the future state."
The workflow teams took a systemic approach to the workflows so the nurses could see how individual processes interact, according to Craig Martin, senior business analyst at UMHS. By conducting mock scenarios of different events, the nurses could become familiar with the technology and with each person's responsibilities for responding to secondary alerts.
In addition to the nurses practicing new workflows, IT staff shadowed nurses to learn about their workflows and gain a better understanding of how the technology could aid nurses in delivering care. "It was critical that all the people working on our project who were from IT understood what it was like — the environment, the demands and the various types of existing communication methods they utilize on a daily basis," Mr. Martin says.
Collaborating as a team
Bringing individuals from across the organization together to work on this project was crucial for its success, according to Christine Szumko, IT activation manager at UMHS. She suggests collaborating with people from different backgrounds, such as biomedical engineering and nursing informatics, in addition to inpatient and emergency department nursing units, and IT. "You need to have a cross-functional team working together," she says. "You have to develop people who can speak across multiple disciplines." For example, the core implementation team — which Mr. Martin, Ms. Szumko and Ms. Thompson were part of — had two activation nurses participate in the majority of some IT meetings to learn more about the technology's application to their workflow. "Our team became very skilled in communicating across traditional hierarchies," Ms. Szumko says.
Implementing new technology
The activation nurses who were part of the core implementation team were trained to be supertrainers to help nurses in their unit integrate the new technology into their workflow. For five weeks the supertrainers and an IT support team worked with the units to perfect the system. To date, the technology has been implemented in three pediatric and newborn ICUs, six general care areas, a pediatric emergency room and a women's birth unit. The new system allows nurses to continue to monitor patients while they are out of the room and call on colleagues quickly to resolve any issues. "The nurses feel connected to what's going on in the patient's room," Ms. Thompson says.
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