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Keeping Patients Safe: Transforming the Work Environment of Nurses
The first of these factors is the environmental design component—an acuity-adaptable headwall (e.g., one that includes additional gas and line outlets). The second is advanced medical–surgical skills on the part of the nurse. The third is identifying the subset of intensive care unit patients appropriate for care in an acuity-adaptable unit. While trauma patients in an intensive care unit typically require highly specialized, intensive interventions, a more hemodynamically stable group, such as coronary care patients, may be able to receive better care on an acuity-adaptable unit that provides both step-down and general medical care. Finally, there needs to be a sufficient number of patients in a like disease state to justify consolidating multiple levels of care into one unit (Gallant and Lanning, 2001).
The committee found only one study that tested the application and safety of acuity-adaptable rooms. This study found significant improvements in quality and operational costs, including a large reduction in clinician hand-offs and transfers, reductions in medication and patient falls, improvements in patient satisfaction, and an increase in patient days per bed on a base of fewer beds (more efficient use of beds) (Hendrich et al., 2004). Further testing is needed on the use of acuity-adaptable rooms as an alternative to transferring patients to a unit staffed with specially trained nurses and other care providers who have benefited from experience with a high volume of intensive care unit interventions.
There are other ways to decrease the risks of hand-offs. They include hospital-wide automated patient records so that there is no temporary loss of patient care information (as can occur when a patient’s hard-copy record is transferred to a new unit), and providing ample space in the patient care room for family to accompany the patient.
Improving information access Good decision making requires good information. This information can best be provided through automated and integrated clinical information systems that provide access to patient information, together with clinical decision support systems (Ball et al., 2003) (see Chapter 5). Information technology used in this way can reduce work errors and inefficiencies.
The increase in safety and efficiency achieved through automated patient records integrated with other clinical information systems is well illustrated by the automated information systems in place at Intermountain Health Care in Salt Lake City (Peck et al., 1997). Access to patient information is facilitated through automated patient records. Patient histories, physical exams, vital signs, and other clinical data are documented on line. When patient records are automated in this way, all patient data are easily accessed and viewed. The nurse can see the patient’s longitudinal history. Little time is wasted in calling to see whether a laboratory test or radiology result is available, because the patient record is linked to the laboratory or