A Focus on Family

Trauma now has 14 workgroups following the PFCC methodology—up from the original seven when it started in 2008, according to David Bertoty, MSN, the clinical director of emergency and trauma services at Presbyterian.

"It's really a continuum of care," says Bertoty. For instance, one workgroup focuses on the arrival and prehospital arrangements of the trauma patient, while another focuses strictly within the emergency department, working to unite the patient with family members and assist communications with physicians. One workgroup monitors connections between the intensive care unit and the ED, and one addresses posttraumatic stress disorder. Another one monitors discharges.

"The unique challenge that the trauma service poses is that the patient doesn't have a relationship with us before they get here when they come in," Bertoty says. "So we're really building that relationship on the fly when the patient is being treated."

Some changes addressing patient/family issues have been small: adding comfortable chairs and computer kiosks to the family waiting area, or scheduling a movie night or Steelers TV game—complete with popcorn—to provide some diversion therapy.

But one major change was restructuring the entire trauma service, which was instituted in 1986. "We discovered in meeting with families that communication was the biggest stumbling block to having more of a PFCC culture," Bertoty says. Specifically, they wanted to know: Who is my doctor and what is my course of care?

To address this dilemma posed by the unit's patient/family advisory board, a decision was made to break the large ICU into three sections (black, gold, and blue). Patients are assigned to a team with two or three attending physicians who can more readily answer patient and family questions. "There's better communication, better continuity," Bertoty says.

"I think [PFCC] has allowed us to look at things in a different way," says Bertoty. Initially, some extra staff work was required, but "if it makes it better for the patient and the family, then there's a trickling-down effect—and it makes it better for the staff members. It's really just turning the tables and changing the focus from the provider to the receiver of healthcare."

The PFCC process looks at care across a continuum, says Maureen Bisognano, executive vice president and chief operating officer with the Institute for Healthcare Improvement, Cambridge, MA. "I think that's really the way healthcare needs to move in order to deal effectively with the kind of ideas that are coming out of the reform agenda."

Overall, she said the PFCC presents a "win-win-win" situation. "The patients benefit from clearly having their care processes designed around their entire journey—from diagnosis until they're effectively independent back at home," Bisognano says. "The families win because they understand what to expect, and they're engaged—they're not nervous bystanders."

But the caregivers benefit also because the "processes are so well-designed that a lot of the hassles and frustrations in daily work are removed," she says. "The organization wins because the costs are driven down and market share expanded as patients are so satisfied and delighted that they are referring their family and relatives for that kind of care."