“They have a part to play on our ACU”

– Gillian, Unit Nurse Manager

“To have the entire team together on the same page, if the nurse or the patient raises an issue we have the computer right there to change orders in real time.”

– Physician

“There is no way in the past that would have happened”

– Ron, MD

“We had a Medical Emergency Team response one night. And one of the new Grad nurses was in charge of this patient, she gave handover to the MET team as they arrived. And I was so proud of her. She did an amazing job and the MET team just looked at her and from their eyes she could have been a nurse with 20 years experience.”

– Charge Nurse

“I’m not worried about going to work anymore.”

– Nurse

“Often in our medical system I think patients sometimes feel they’re left out: what’s going on with their treatment, when are they going to see their doctor next. It was incredible what I saw… Less time waiting for an in-patient bed, shorter hospital stays, better patient outcomes, and an increased patient and family, and staff satisfaction.”

– CNO

“This is more than just a Unit, this is a culture change. The other floors want to look like the [ACU]… This is the way to do it.”

– CMO

“A resilient ward with people who just do it”

– Ron, MD

“Strangely, the chaos in traditional hospitals is still considered normal. Leaders seem genuinely surprised by complications and delays. So many resources and hours are wasted recovering from what could’ve been prevented in the first place. Our ACU reverses all that and the difference is profound. Every hospital unit should work this way.”

– Unit Medical Leader

“I really liked the quality safety checklist with the Foley Catheters. Sometimes I think they get left in longer than they’re supposed to. People forget about it. You know, foley was in and this has been in for so many days, can we do a voiding trial on this patient?”

– Nurse

“We’re incorporating [the] patient more with the bedside handoff reports so they’re more aware of what’s going on with their care. And, their questions and their input.”

– Nurse

” I think the good thing about the [Nurses First] bedside handover is that you can tweak it to your unit. So handovers before would not have been potentially as accurate as what I would like them to be or expect them to be. Whereas now we’ve got this process and yeah you could give that handover and it’d be 98% accurate.”

– Unit Nurse Manager

“Nurses hear [the information] for the entire floor. So it triggers you to say, okay, so 21 has a bed alarm. That’s not my patient, but 21 has a bed alarm, so I need to make sure that if something happens in that room, I [know when I] go in there, we’re all responsible.”

– Nurse

“The changes on the Unit have made my recent stay very different to my previous ones. I feel listened to. I feel like my needs are being met quickly. And I like the daily rounds where I see my doctor and my nurse.”

– Patient

“I think change of shift huddle is exciting. The nurses really enjoy that and they take time to prepare the change of shift huddle … it’s unbelieveable. They’re doing a great job at it. So I think that’s something that’s really enjoyed.”

– Unit Nurse Manager

“I don’t know how … we haven’t done this yet. It just makes sense. It makes sense for patient safety, and for patient advocacy. Just to have the physician there and support me as nurse, and know that he or she has my back and I can communicate face-to-face with that physician. That’s very important to patient safety.”

– Nurse

“Remove the barrier between disciplines”

– Alana, Physiotherapist

“It’s totally patient-centred… We can tell you exactly what time the doctor is going to come every day… We’re not spending all day trying to get a hold of doctors.”

– Nurse

“The Accountable Care Unit makes patient interactions more meaningful and predictable, which is decreasing patient length of stay by eliminating barriers to discharge.”

– VP Practitioner Staff Affairs

“[It elevates] what nurses have to communicate. It’s professionalism, it’s accuracy…So learn it, stick with it, follow our lead and you won’t be sorry.”

– CNO

“A young nurse had to handover a patient to the ICU team, went over there with absolute confidence standing in front of ICU physicians and nurses all staring at her. She didn’t feel nervous because she just pulled out the bedside handover tool and she just went through it like we do on the ward, systems approach, and then she looked at everybody. She expected all these questions to come, but she’d covered everything. Not even the doctors had any questions and she came back to the ward really proud and really confident that she’d given it a great handover.”

– Charge Nurse

“we recognize change fast because we’re attending rounds daily, so when someone starts to do really well and maybe not do so well, it’s recognized that day, not a week later”

– Physiotherapist

“I was suspicious. It sounded too good to be true… When I started working on the ACU I felt how different it was. My days used to be filled with running from floor to floor, getting paged by worried nurses to come urgently to see a patient, flipping through patient charts trying to find that important piece of nursing information that would be key to understanding. Now I’m part of a team. And with that team I go and see the patients and listen to them and find out what are their key priorities that need to be addressed… I love my job again.”

– Unit Medical Leader

“Two and a half months ago that [we] implemented [our] first Accountable Care Unit… So far this system has had a very positive impact on patient care. On average patients on this unit are heading home two and a half days earlier.‘

– President and CEO

“The bedside report that we use in bedside handover gives you a head to toe assessment. It keeps you organized so you’re not  bouncing between subjects. And it paints a better picture that way.”

– Nurse

“What we found was … more patients identified actually had an intervention performed by a pharmacist that aligned with our standards compared with the comparator ward.”

– Pharmacist

“The change of shift huddle kind of gets everybody ready, gets everyone there and … gives you a positive attitude for the day and you know incoming admissions, discharges, what’s planned.”

– Nurse

“From their eyes she could have been a nurse with 20 years experience”

– Ellen, RN

“This is the best model for coordinating care that I’ve ever seen. Patients spend less time in the hospital, get better quicker, and don’t bounce back. Our Accountable Care Unit helped us establish a culture of safety. Now we have a unit where patients don’t die and don’t even fall.”

– Unit Medical Leader

“We are already seeing how physically locating these physicians in one place and the subsequent regular interactions through standardized rounding, is improving teamwork and communication among our care provider partners.”

– CMO

“I really like the quality safety checklist with the Foley Catheters. Sometimes I think they get left in longer than they’re supposed to. People forget about it. You know, foley was in and this has been in for so many days, can we do a voiding trial on this patient?”

– Nurse

“I think it cuts out all the unnecessary information that isn’t needed that nurses may just pass on that doesn’t need to be included. So it keeps us focused on the patient and what they’re here for and the medical facts and not social things or other things that can sometimes creep into report.”

– Nurse

“There’s not as many fires to put out because we see issues before they happen”

– Alana, Physiotherapist

“This care model has brought real teamwork to our hospital. Beforehand, doctors had no idea what members of the care team were doing and nurses knew very little about what doctors were thinking. Today, those problems are gone. Communication is infinitely better and there’s a collegiality and empathy among staff that many of us never imagined was possible.”

– Unit Medical Leader

“What is the why for SIBR? The patient is the why!”

– Cassie, RN

“Physicians and staff are making comments like, ‘This is what medicine is supposed to be’ or ‘This is the work environment I always envisioned working in”

– Director of Patient Flow

“I try to listen to which patients either have fallen or we’re very worried about falling because if the bed alarm goes off and you’re the only person sitting in the nurses station, you want to know how fast should I run to that bed alarm? I think that’s very useful information that we parse out in the morning huddle.”

– Charge Nurse

You’ve got a structure and you make sure you don’t miss anything. It’s really easy to just write in the information and as you go through you think of something that you didn’t even remember at the time, but because it’s already there to sort of remind you, it helps with bringing on that memory. But I think [Nurses First] is really good.

– Student Nurse

“I have the opportunity to ask questions about going home and what I need to do when I get home so that’s good.”

– Patient

“If I had to tell myself something now that I wish I knew three, six months ago, it would have been, we should have done this sooner. We should have been after Nurses First a year ago.”

– AVP Acute Care

“If we have relieving staff, we use the huddle to introduce them. Everybody says hi, we let everybody know their name and who they’re working with so that people can see them in the corridor and check in if they’re okay and they know their name. It historically has made the relieving staff really feel welcome and valued and happy within the unit and happy to come back to the unit as well.”

– Charge Nurse

“I try to listen to which patients either have fallen or we’re very worried about falling because if the bed alarm goes off and you’re the only person sitting in the nurses station, you want to know how fast should I run to that bed alarm? I think that’s very useful information that we parse out in the morning huddle.”

– Nurse

“Help her to be a great member of this team, even if it’s only for today”

– Sarah, RN

“The ACU difference is dramatic. It’s like we have twice the number of hands on deck, but we haven’t hired anyone new. We’ve just trained everyone to coordinate with each other and with greater purpose. You can see this remarkable belief here now. We know we’re delivering the care we’d want for our family members or ourselves.”

– Unit Medical Leader

“She came back to the ward really proud and really confident that she’d given it a great handover”

– Amy, RN

“It’s a more fun way to work”

– Dr. Todd

“It’s been amazing how this has played out.”

– Kathy, AVP

“When you do it this way you have a cohesiveness on the unit”

– Ashlie, RN

“We’ve been teaching the same way for 50 years, but with this care model we now teach delivery of care. This is exactly where healthcare is heading. Staff and trainees today need to understand that prescribing a therapy is the easy part. The hard part is getting a huge, complicated system to deliver that therapy to the right patient at the right time, while being alert enough to recognize-and-respond when therapy fails or patients drift off course. Traditional hospital care does none of that. But this care model does. This is the future. This is the ‘new way’ and the ‘old way’ just looks crude and unacceptable by comparison.”

– Unit Medical Leader

“Nurses first has given us that structure that I think we need as nurses.”

– AVP Acute Care

“Our metrics improved on every category”

– Dr. Jon

“When I first started working here, everyone liked to give and also to receive a different type of handover and they wanted different information … this one gives everyone a structure so we get the continuity of what we’re giving and receiving. So it makes it timely and makes sure that nothing important gets missed out. So I really like that.”

– Nurse

“so my job becomes a little bit easier because I don’t need to think about all the other pieces that I should have maybe known. I don’t need to know the answer because I have a team member who can answer that out for me”

– Pharmacist

“There’s a great continuity and a safety net effectively for every patient, every time, every day.”

– Sarah, Charge Nurse

“When I got to the unit, I was depressed. The team of people on the unit really talked to me and turned my attitude around.  They got me on a better path so I was able to go home.”

– Patient

“There’s a couple of times that we’ve had patients that have needed a little bit more emotional support. And so that’s been noted in the change of shift huddle, which I think is really appropriate, especially for us [nurses] because we’re all in and out of each other’s rooms for most of [the] shift.”

– Nurse

“It has truly changed the way that we start our shift…it’s just amazing how this has played out.”

– Director of Nursing

“This is the way healthcare should be.”

– Patient

“The care was remarkable … We should be so lucky that this kind of care is available to more people in our community. Just to be able to meet regularly with the physician and the nurses, to know what is happening.”

– Family

“Less time in hospital, the freeing up of beds. The care is better. The communication is better.”

– Chair Regional Health Authority

“Highlight of my career”

– Nancy, Pharmacist

“There’s a couple of times that we’ve had patients that have needed a little bit more emotional support. And so that’s been noted in the change of shift huddle, which I think is really appropriate, especially for us [nurses] because we’re all in and out of each other’s rooms for most of [the] shift.”

– Nurse

“I think a lot of the value from change of shift huddle in the morning is you get how many people are leaving, how many surgeries you expects, DNRs, high fall risks, runs through all of the important things that you need to know if something’s happening in a room and it’s not your patient and you just happen to run in, you can say I remember this patient’s high fall risk and take the right actions.”

– Nurse

“We see the benefits of having the uniform process.”

– Amy, RN

“Accountable care gets rid of the chaos and fosters teamwork with all people providing care and with a much improved relationship with the patient and their families. It’s so obvious to me that this is what we’re supposed to be doing.”

– Unit Medical Leader

“[This] is a skillset that we knew we needed…Staff watched the video and had immediate interest, asking “Where do we sign up?”

– CNO

“An innovative model of team based patient care.”

– State Minister of Health

“SIBR made a remarkable change”

– Dr Kish

“I believe that pharmacists should see this because it’s a real eyeopener in my opinion. It’s the way pharmacy should be done in a hospital and not working in isolation, making your solutions and figuring out problems that don’t actually even exist, right?”

– Pharmacist

“[Nurses First bedside handover] gives you information and it gives you a reliance on your, on your team member that you’re going to get the information you need to have a great experience with that patient.”

– Director of Nursing

“We rolled out hospital-wide almost overnight. We were able to embed the same process for change of shift in every unit. We were able to free our nurses to focus on care, not information gathering.”

– CNO

“At the risk of sounding like someone who is drinking the Kool-Aid, having reached the stage we are at now, and seen the changes and opportunities that exist in organizing care this way…if this does not become standard operating procedure, I will have to look for another job because I cannot imagine working somewhere that doesn’t support the value this is creating.”

– Physician

“We knew when to expect [the care team] each day and knew they would answer all of our questions.  They knew our names and really involved us in the process.  It really is a wonderful”

– Family

“I think it cuts out all the unnecessary information that isn’t needed that nurses may just pass on that doesn’t need to be included. So it keep us focused on the patient and what they’re here for and the medical facts and not social things or other things that can sometimes creep into report.”

– Nurse

“Physicians seek out that nurse”

– Brittany, RN

 

“Having something already filled out by the previous nurse, handing it to you, and you going in together, you’re just looking along and you can listen, you’re not worried about writing down and that’s made this much easier.”

– Nurse

“[Nurses First] enabled us to really get to the, to the patient, get to that bedside, make it patient centric and talk to the patient and involve them in that conversation… we had gotten away from that.”

– AVP Acute Care