Background: SIBR originated from a multi-pronged initiative to improve value and outcomes for our patients. On the Oncology floor where the complexity of care is high and patients have several consultants involved in their care, it is very easy to have fragmentation of care and lose the patient’s trust. Our objective was to engage the patient with the Hospitalist team, support them in understanding their plan of care and be available to address their concerns early in the day.
Purpose: To pilot SIBR on the Oncology floor and evaluate its impact on the patient’s quality of care using Press Ganey Scores and operational indicators such as LOS.
Description: Being the first team to pilot SIBR at our hospital gave us the opportunity to develop a format to SIBR that would provide the most value to our patient population. SIBR will look different for a team that is taking care of Oncology patients versus those on Telemetry. To understand the complexity of Oncology patients, compare the CMI (Case Mix Index) on different units:On the Oncology floor the CMI is 1.8-1.9, on Telemetry, it is 1.3 and on General Medicine floors, it is 1.5. The team, which consisted of the Hospitalist, Primary RN, Nurse Manager, Case Manager and Social Worker met at 830AM, and on average saw 14 patients during bedside rounds that lasted 90 minutes. To improve the patient’s understanding of their plan of care and address concerns, we used this opportunity to ask the patient open-ended questions such as “What is bothering you the most?” or “What is your understanding of what’s going on?” to create more value for the patient. This approach created an environment of trust and the patient’s responses to these questions were pivotal in developing the plan of care. Additionally, a project manager audited the quality of SIBR by gathering data on punctuality, attendance, number of patients seen, time spent on individual patients, and total time spent on rounds. We regularly reviewed this data in a brief huddle at the end of rounds for quick feedback to implement the next day. We studied the impact of SIBR by analyzing our HCAHPS scores and operational indicators comparing data 6 months pre- and post-SIBR.
Conclusions: Patient Experience scores improved in the following domains: Top Box Performance for Communication with Doctors improved from 81.8% (78th Percentile) to 84.3% (85th Percentile).Top Box Performance for Communication with Nurses improved from 83.3% (85th Percentile) to 87.6% (94th Percentile).Pre- and Post- SIBR Operational Indicators demonstrated mixed results:Percent Discharges by 2PM showed a slight improvement from 21% to 23.3% .LOS saw an uptick from 4.8 days to 5.2 days 30-day All-Cause Readmission rate – went up from 15.1% to 15.4% Falls decreased from 5 to 1 in 6-months pre- and post-SIBR implementation. This was attributed to checking bed alarms at rounds and identifying patients with pain or delirium early in the day. There were several benefits that were perceived and could be measured in future studies. SIBR helped reduce the number of times the patient was interrupted during the day. It also helped reduce the number of texts and phone-tagging within the team. Staff engagement was perceived to be high. We hoped to see an improvement in LOS and readmission rates as well and plan to examine how we can use SIBR to impact these areas. It is worthwhile also to see if there was a reduction in the number of RRTs.
