Chinese Hospital created a detailed care plan with daily learning goals and clinical interventions.
Length of stay benchmarks for CHF patients were around 3-4 days, but our patients were staying much longer. This was partly because most of our patients have multiple diagnoses, but we still wanted to structure our care better to shorten hospital stays.
Chinese Hospital is a non-profit hospital in San Francisco, CA. It has 54 beds and serves a primarily elderly (average age of 76) monolingual population with most patients speaking only Chinese. Their transitions program began in 2008 and is influenced by IHI’s Transforming care at the Bedside and the Care Transitions Program.
What We Tried
We referred to best practices around CHF, consulted our doctors, and reviewed our current processes to develop a detailed care plan for CHF patients. For each day, we had clear learning outcomes and clinical interventions. As the bed nurses completed each task, they would date and initial it. For example, on day 1, nurses teach patients about low sodium diets. On day 2, they cover monitoring of breathing and swelling, and on day 3 they cover weight monitoring. If the patient can successfully teach back everything on day 3, they can be cleared for discharge.
We haven’t achieved our 3-day goal yet, but our patients are receiving more thorough and consistent care throughout their stay. Our nurses also feel more confident because they have clear tasks and objectives every day.
This care plan has raised awareness of our transitions program in a positive way. Working closely with nurses and doctors to develop the plan helped establish strong relationships with them.