Redesigning Erickson Health's nursing rounds process

  • Flow chart of the solution

Audacious Inquiry undertook a business process modeling (BPM) and redesign project for Erickson Health, whereby a complex nursing rounds process was reengineered to improve the quality of care for many Erickson patients. Erickson Retirement Communities provides care to more than 20,000 American seniors over the age of sixty. Renaissance Gardens, a division of Erickson Health, is the nation’s premier provider of assisted living, physical therapy, and skilled nursing care. However, senior management at Erickson was concerned about significant flaws in the monthly rounds process, which was both time-consuming and inefficient. Audacious Inquiry was engaged in the implementation of an integrated digital solution for streamlining the patient rounds process at the network of long-term care nursing campuses.

The team began with a thorough analysis of existing processes and policies. The clinicians on the interdisciplinary team were educated on the potential for technical solutions to their everyday challenges, while the IT–focused members of the team became versed in the clinicians’ best practices. The team developed a data set that, in its view, represented the core clinical elements of an effective monthly rounds visit, including data points on oral intake, weight, falling, skin integrity issues like pressure ulcers, mood, cognition, behavior, anxiety, and sleep. Preventative strategies being pursued and observations of acute changes were also included in the data. Additionally, the new nursing documentation system integrated with a physician electronic records application to enable caregivers to track every aspect of treatment for its elderly patients.

As a result of our BPM solution, improvements were seen in coordination of care, time efficiency, and cost savings. Nursing summaries went from being completed less than 60% of the time to being done on all campuses electronically nearly 100% of the time. Provider notes went from being done on paper or by transcription to being done electronically nearly 80% of the time. Efficiency savings were observed in a study done by one provider who showed that residents now receive about 30% more face-to-face contact during a typical rounds process. Finally, financial benefits were realized as transcription costs vanished and visit coding was improved by $1.72 per visit. In general, our solution met Erickson management’s goal of improving business intelligence collection by streamlining documentation, creating standards for digitized content, improving communication of clinical information, and enhancing quality of care, resident satisfaction, compliance, and reimbursement.

In April 2007, Erickson Health was named the winner of Health Data Management’s 2nd Annual Nursing Information Technology Innovation Award, which recognizes innovation and excellence in using information technology in the field of nursing to directly improve the quality of care and patient safety and/or promote the effective use of nursing resources. The project also won a Gold Level John C. Erickson Award for Innovation.