In 2007, Cedars-Sinai Medical Center in Los Angeles rolled out a "universal floor" during an expansion project. In the time that has passed, Cedars-Sinai's innovation has lowered wait times for patients being admitted from the ED and elsewhere, reduced the number of patient safety events, and increased staff member satisfaction.
A universal floor is one on which most patient consultations can take place. Rooms are created with multiple types of patient care in mind and staff members are trained in many specialties to facilitate patients' needs on the one floor. This reduces the need for patients to travel throughout the hospital.
The idea for developing a universal floor came at a time when the hospital was designing a new critical care tower. Staff members decided to trial the idea after hearing of the success of a universal floor at Methodist Hospital of Clarian Health in Indiana.
"We thought we could have a unit where we could ensure that all of the staff were capable of providing the levels of care that included a step down unit as well as a general medical unit and a tele-unit," says Linda Burnes Bolton, Dr.Ph, RN, FAAN, vice president and chief nursing officer at Cedars-Sinai Medical Center. "Second, in terms of the construction of the unit, [it] would facilitate idealized design…about creating units where you minimize the amount of time staff are out of the patient's room and maximize the amount of staff are in direct care with the patient."
A growing body of data show that increasing the amount of time nurses are in direct contact with patients leads to the best patient outcomes. Nurses are better able to rescue patients and prevent harm from occurring, says Burnes Bolton.
Additionally, Cedars-Sinai wanted to address patient flow issues occurring due to a lack of available beds and a constant influx of patients needing beds, similar to many hospitals in the country. Ideally, the universal floor would be able to accept patients who were visiting with their doctors and complaining of chest pain, for example, without having to go through the ED. Often physicians will send patients to the ED as a last resort because of the lack of open beds.
Design pays off
In addition to improving patient flow throughout the hospital and reducing patient safety errors, the universal floor has allowed staff members to spend more time with patients, making for a more comfortable patient stay.
"The most important piece is that the units [were] designed [to] facilitate the ability of the team to intervene early and to provide more time for direct patient care," says Burnes Bolton.
Because of the workflow redesign on the universal floor, staff members on the universal floor have significantly cut down on waste. Nurses have been encouraged to be active players in patient care and share their creative ideas for new programs and procedures on the floor. For their creative ideas to flourish, however, the hospital needed to allow them time for development and implementation.
"Nurses can't do that if they're spending so much time on documentation or spending so much time hunting and gathering supplies," says Burnes Bolton. They need time to be able to educate patients and engage families.
Creative ideas encouraged
Some examples of how staff members on the universal floor have been encouraged to contribute ideas for better patient care can be seen in the efforts they have taken to reduce readmission.
Cardiac patients on the universal floor are given special attention before and after they are discharged because of the known high rate of readmission with that set of patients. A team of nurses on the floor works with cardiac patients to ensure that when the patient is discharged, he or she has the proper tools to help keep him or her from returning to the hospital. This includes a home visit by a member of the staff to evaluate risks in the home, as well as interviews with the patient and his or her family.
One nurse had the idea to create a unique teaching aid to help cardiac patients learn best practices upon their discharges. Called the "Deck of Cards" program, the initiative requires staff nurses to create a unique deck of cards (like playing cards) that act as a teaching aid. The content of the cards is based on what the nurse who visited the home found and on the interviews conducted, as well as patient preference.
To read more about the universal floor and the innovative ideas that have come from it, see the October 2009 issue of Briefings on Patient Safety.