Transforming Care at the Bedside (TCAB)

The MUHC has just begun its second year of Transforming Care at the Bedside (TCAB). This initiative, led by Patty O’Connor and the MUHC Nursing Department, is about increasing the time nurses and other professionals spend with patients by improving the physical environment and work processes. According to Ms. O’Connor, the MUHC Director of Nursing and Chief Nursing Officer, “the aim of TCAB is to understand care through the eyes of patients, and to then engage patients and staff in co-developing and testing new work processes that will decrease waste and inefficiency, improve the quality of care, improve patients’ and families’ experiences of care and strengthen interprofessional approach.”

The “how” of TCAB focuses on teaching frontline teams – composed of interprofessional staff members and patient representatives – how to do Rapid Cycle Improvement processes using Plan-Do-Study-Act (PDSA) cycles, so that they can become the owners and leaders of the improvements needed. Each unit chooses the areas for improvement, then conducts simple tests of change, with pre and post measurements. Extensive feedback on patients’ experience of care has also been obtained via surveys and patient interviews.

Results from the first year have been positive, and for the most part sustained: 1) introduction of a Quiet Zone for medication documentation resulted in a 50% reduction in interruptions and 60% reduction in transcription errors; 2) equipment re-location significantly reduced hunting and gathering time and eliminated test cancellations related to lack of transport wheelchairs; 3) patient and staff redesigned a chemotherapy treatment room, reducing the time to start chemotherapy by 57%; 4) implementation of a joint interprofessional admission process (RN, psychiatrist and social worker) in mental health reduced the admission time from 4.3 to 1 hour, eliminating duplication, improving team communication and cross-discipline learning.

On September 27th and 28th, Phase II of TCAB was launched at the MUHC. Implementation is continuing on the same five pilot units as Phase I, but with some significant changes in approach. In the second phase, the teams are continuing to perfect their use of PDSA cycles to make improvements, but are all working on the same types of improvements simultaneously. These include redesigning the physical environment using 5S (Sort, Set, Shine, Standardize, Sustain), understanding and improving patient’s experience of care and optimizing admission and discharge processes. We’re hoping for significant and consistent improvements in outcomes and more opportunities for spreading lessons learned and strategies for implementing sustainable changes to how we provide high quality, patient-centered care.