title: Redesigning the Patient Observer Model to Achieve Increased Efficiency and Staff Engagement on a Surgical Trauma Inpatient Unit.
abstract: BACKGROUND
  Provision of safe and efficient observer care to inpatients whose behavior puts them at risk for injury is a clinically challenging and costly endeavor for hospitals. At Massachusetts General Hospital (MGH; Boston), process improvement strategies were deployed to provide staff with an improved clinical model for patient observation, unit-based responsibility for allocating resources, and strategies to maintain a safer environment.
  
  
  METHODS
  In a surgical trauma unit at MGH, a team of nursing leaders and clinicians created an innovative process to identify, assess, and develop best practices for ensuring patient safety in the hospital environment. Patients with delirium were identified as the most prevalent and concerning patient group, and specific interventions were developed to address their unique needs. From December 2012 through June 2014, the team successfully piloted the best practices (July 16, 2013-September 30, 2013) and implemented them.
  
  
  RESULTS
  The baseline outcome metric of patient observer direct-care hours decreased from a median of 208 hours/week (January 1, 2012-July 13, 2013) to a median of 112 hours/week (July 14, 2013-June 28, 2014); a 46% decrease in utilization. Fall rate (falls per 1,000 patient-days) remained unchanged postimplementation, and staff satisfaction with the patient observer model increased from 9% to 72%, while costs associated with providing observer care remained stable.
  
  
  CONCLUSIONS
  Providing the inpatient unit staff with the knowledge and tools needed to optimally manage patients with at-risk behaviors, including delirium, significantly decreased the number of staff hours spent at the bedside providing observation, did not negatively affect the unit fall rate, and increased staff engagement at no additional expense to the unit.
authors.affiliation: Center for Quality and Safety, Massachusetts General Hospital, Boston, USA.
authors.forename: Pratik
authors.initials: P
authors.lastname: Rachh
authors.forename: Gianna
authors.initials: G
authors.lastname: Wilkins
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Capodilupo
authors.forename: Susan
authors.initials: S
authors.lastname: Kilroy
authors.forename: Maureen
authors.initials: M
authors.lastname: Schnider
authors.forename: Jennifer
authors.initials: J
authors.lastname: Repper-Delisi
mesh_terms: D003693:Delirium / Q000503:physiopathology*; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D007297:Inpatients; D007318:Inservice Training; D008297:Male; D009728:Nursing Assistants / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D061214:Patient Safety; D010865:Pilot Projects; D017064:Process Assessment, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*; D018570:Risk Assessment; D000092864:Suicide Prevention