The countdown has begun.
After greater than 4 years of building, the Pavilion, Penn Medication’s new 1.5-million-square-foot inpatient facility on the Hospital of the College of Pennsylvania (HUP), will open for affected person care on October 30. To make sure a easy transition, well being care groups shifting throughout the hospital campus have undergone intensive coaching, together with “rehearsals” of day-to-day processes.
Now, in lower than two weeks, the ultimate piece of this complicated course of can be put into motion: safely transporting nearly 400 sufferers —together with probably the most complicated —of their beds throughout the hospital campus. Your entire course of should be accomplished over the course of a single day, whereas barely interrupting the circulate of affected person care.
Planning this herculean activity has been ongoing for months. Mapping out this transition — figuring out, for instance, the order and time through which every unit must be moved, which employees ought to accompany every affected person, and affected person room assignments — has required enter from a multidisciplinary group of stakeholders. This contains not solely nurses and suppliers but additionally Scientific Engineering, Data Providers, Services, Admissions, and assist providers for affected person care, reminiscent of radiology and lab drugs, amongst others. Neil Fishman, MD, HUP’s chief medical officer, and Paul Harrington, MSN, MBA, HUP’s affiliate chief nursing officer, have served as government leads, with Kelly Hoenisch, MSN, Surgical procedure division director for Cardiac, Transplant, and Vascular Surgical procedure, who’s the operational lead.
Transferring an Emergency Division in an On the spot
As a result of the circulate of sufferers into the emergency division (ED) is so unpredictable, the switch of emergency care from the present ED location in HUP’s Silverstein constructing to the Pavilion wanted a method of its personal to make sure a easy transition. And that occurs very first thing within the morning on transfer day.
Right here’s the plan: At precisely 7 a.m. on October 30, the ED in Silverstein on the west facet of 34th Avenue will shut and the Pavilion’s ED on Conference Avenue will open, concurrently. “It is going to be a agency cutover,” mentioned Robin Wooden, PhD, RN, scientific director of Emergency and Commentary Nursing. “HUP will solely have one lively ED.” Each places, nonetheless, will remained staffed till the final affected person on the present ED is handled and both discharged or admitted to a unit.
To assist sufferers who arrive on the present HUP ED after 7 a.m. on the Pavilion’s opening day, “Safety and one or two ED nurses can be stationed within the legacy ED ready room to assist redirect them to the brand new location,” Wooden mentioned. An ambulance can be accessible to switch sufferers with trauma or acute emergency to the Pavilion, however the HUP ED “can have the aptitude to ship speedy care to any really emergent affected person,” mentioned Keith Hemmert, MD, medical director of the ED, for instance, somebody having coronary heart assault or stroke, or gunshot sufferer. “What’s most necessary is affected person security.”
Two care pathways can be used for sufferers arriving on the HUP’s Silverstein constructing ED previous to 7 a.m. who must be admitted to a affected person care unit shifting to the Pavilion. Relying on when that unit is scheduled to switch care, “the affected person will both be despatched as much as that unit that’s slated to maneuver later within the day and transported over with the remainder of the unit or stay within the HUP legacy ED an hour or two longer, till that unit has moved into the Pavilion,” Hemmert defined. “At this level the affected person can be despatched on to the affected person care unit within the Pavilion.
“We’ll collaborate with the affected person command middle to see the place we will match that affected person into the transfer sequence,” Hemmert mentioned. “It is going to be a case by case, unit by unit, affected person by affected person choice.”
A Hospital on the Transfer, 12-15 Sufferers at a Time
Right here’s how the transfer will happen for the tons of of HUP inpatients whose models will quickly be relocated to the Pavilion.
Beginning at 9 a.m. on October 30, sufferers in Vital Care models would be the first to be introduced throughout the road. Solely when these sufferers are safely within the Pavilion will the following unit on the schedule begin the transitioning course of. Hoenisch mentioned they labored carefully with leaders of every unit to schedule the transfer time, being respectful of operations that have to occur first, reminiscent of nursing evaluations and interventions, giving drugs, and permitting time for sufferers to eat breakfast.
Relying on affected person acuity (how sick the affected person is), the transport staff accompanying the affected person would possibly embody a number of individuals. “It’s very affected person particular, consisting of no matter a affected person wants,” she mentioned. So, along with the affected person transporter and the affected person’s care staff, there may be additional assist employees, reminiscent of a respiratory therapist. “We’re additionally creating an RN transport staff only for that day, to offer one-on-one nursing for the precise bodily transfer of every affected person,” Hoenisch mentioned. “As soon as they get to the Pavilion, the affected person’s major nurse will assume their affected person’s care.”
Sustaining continuity of look after every affected person is a prime precedence, Hoenisch pressured. “There can be no further handoffs on the Pavilion, which is greatest for the affected person,” she mentioned. As a HUP unit empties, affected person care groups will cross to the brand new location with their sufferers. It’s only when the final affected person has been moved out of the unit that the final care staff will go away and the unit can be empty.
Along with the scientific care staff accompanying every affected person, “all routes can be strategically aligned with security observers and clinically emergency assist for any modifications in affected person situation,” Hoenisch mentioned. All instructed, there can be 350 clear and recognized roles of obligations.
Throughout that day, 4 sufferers can be moved concurrently on considered one of 4 designated tracks (i.e., routes by means of HUP to the Pavilion) to the affected person bridge or tunnel resulting in the Pavilion. “Our current care areas have an enormous footprint however leaving the constructing shouldn’t be at all times a straight shot, she mentioned. For instance, Rhoads and Silverstein are very straightforward to maneuver sufferers out — they’re each so near the tunnel or bridge main into the Pavilion — however Founders is more durable; there’s extra strolling concerned to get to the monitor. “We’re going into a bigger footprint however the elevators are centralized and hallways are straight.”
The estimated time to maneuver a affected person will vary from 8 to 12 minutes, relying on how a lot tools (for instance, IV poles) the affected person wants to make sure a protected crossing. “At anyone time, 12-15 sufferers can be mobilized,” she mentioned.
The transfer has been months within the planning however the days — and hours — earlier than the transfer can be particularly essential to its success. “We plan to fulfill with Admissions and nurse managers from all areas on Monday that week, working affected person censuses, taking a look at acuity challenges and potentials for discharge,” Hoenisch mentioned. “And we’ll do it once more with our Admissions companions at 4 a.m. on the morning of the transfer, growing a queue record to grasp what affected person is being slotted to what mattress. And, to find out if a affected person’s scientific scenario worsens, what would be the plan inside the unit,” for instance, shifting a non-ICU affected person into an ICU.
Hoenisch mentioned that the transfer was deliberate with “our sufferers and households in thoughts. We would like it to have a really constructive impression to their day, to their medical interventions and coverings,” she mentioned. “They may proceed to obtain the superb care supply that introduced them to HUP — and, they get to play an element in a historic second at Penn Medication.”
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