During the height of the pandemic, healthcare organizations found themselves confronted with a supply and demand challenge, scrambling to care for a surge of extremely ill patients with too few bedside nurses.
They shifted resources to meet the demand, pivoting to care for as many patients as possible. While COVID-19 is no longer a national health crisis, similar challenges persist today. Exhausted and burned out, hundreds of thousands of nurses have resigned, retired, or sought role changes, resulting in alarmingly few nurses safely delivering care – at least under today’s primary nursing model.
While nursing schools are doing their part to graduate the next generation of nurses, they also struggle with shortages of faculty and clinical sites impacting much-needed real-world training. It is widely accepted that the vast majority of new graduates are not fully practice-ready upon graduation, most needing support and supervision by more experienced nurses to ease the transition.
Adopting a team-based model
“The primary nursing model is no longer working in many healthcare organizations,” explains Wolters Kluwer Chief Nurse Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN. “Lack of an adequate number of competent nurses at the bedside is leading many organizations to implement a team model of care.”
This involves pairing experienced nurses to oversee the care provided by novice and support personnel. Unlike today’s primary nurse model, it permits fewer registered nurses and more support personnel to manage a larger number of patients and allows for the adoption of telehealth, which rapidly expanded during the pandemic.
This more agile care-delivery approach ensures nurses are proficient in both primary- and team-based models, so hospitals can switch between them depending on the situation. It also ensures that nurses are trained in remote care delivery via telehealth.
Team-based care is not new
The team-based care concept dates back to World War II when the military faced a shortage of nurses to care for patients, training ancillary staff and medics to work with nurses in a team-based model. Later adopted by the Veterans Administration hospital system, it eventually spread to other hospitals.
Today’s team-based model differs from its predecessor in two important ways:
It relies more on an interdisciplinary approach to care by expanding to other healthcare professionals beyond nurses to manage critically ill patients; and
Teams are managed by a team leader with knowledge and experience in critical care or specialty care who can oversee nurses and other personnel moved to the unit to assist with care as direct caregivers.
Because the model accommodates staffing agility, hospitals can quickly train support staff such as unlicensed assistive personnel, physical therapists, respiratory therapists, and others to assist with patient care. This interdisciplinary team-based approach facilitates the rapid deployment of staff to areas most in need.
Another approach to patient-centered care, adopting a team-based model takes advantage of each team member's talents and experience and provides an alternative care delivery framework. It also increases flexibility and agility, allowing nurses to work at the full scope of their practice and licensure.
Research supports team-based nursing
Research shows that team-based nursing can improve quality, patient safety, and levels of staff satisfaction. One transitional care unit implemented team-based nursing in its 18-bed high-acuity, bedside telemetry, step-down unit in response to an influx of new hires, increased levels of patient acuity, and decreased staff morale. The team-based nursing model was easily adapted to meet the needs of the unit, providing staff with the support and collaboration they were craving and resulting in:
88% compliance rate in team-based nursing participation
11% increase in staff feeling supported during their shift
20% increase in staff being held accountable by peers
45% increase in staff perception of continuity of care
Looking to the future
Ultimately, team-based models support a more diversified workforce that is prepared to care for a disparate population, promote wellness and address systemic inequities. Nurses are in a unique position to facilitate today’s changing paradigms of care, especially in collaboration with nursing education.
“Now is time,” says Woods, “for healthcare organizations to update their staffing strategies to become more agile and efficient, building on lessons learned and institutionalizing those learnings into a team-based nursing delivery approach in collaboration with academia. Healthcare and academia need to evolve to address the changing landscape of healthcare to support innovation and collaboration between interdisciplinary healthcare and practice teams.”
To learn more, download our eBook, “Transforming the Nursing Workforce: Keys to Delivering Health Equity and Fostering Resilience,” here.
How innovative Clinical Decision Support technology drives better care decisions and patient outcomes
Thirty years ago, a physician with a clinical question on a patient case had two choices: consult with a colleague or other healthcare professional (research shows this only leads to answers less than 30% of the time1), or seek guidance from the medical literature, which required a time-consuming trip to the medical library. Thankfully, advanced Clinical Decision Support (CDS) solutions now help clinical teams make the right medical decisions in real time. These solutions help to reduce care variation and improve care coordination by enabling physicians to connect within their workflow to clinical, pharmacy, and patient engagement content that is evidence-based.
“Given the voluminous amount of healthcare information available today, clinicians need medical and faculty experts to distill it down into a discrete recommendation for a specific patient type, and they need an entire experience that is easy and transparent,” says Peter Bonis, MD, Chief Medical Officer at Wolters Kluwer, Health.
Influencing care decisions with the right information
Research shows that widespread usage of CDS technology is associated with improved patient outcomes and hospital processes. Multiple studies—including one from the University of Chicago2 — have found that over 30% of CDS topic views were associated with changes in clinical decisions, including diagnoses and treatment approaches. Additionally, a Harvard University study found that one CDS tool was associated with many benefits over three years, including 372,000 hospital stays saved per year, fewer complications, improved patient safety measures, and even a reduction in mortality rates with 11,500 lives saved.3
As patient data increases, thanks to Electronic Health Record (EHR) advances, improved interoperability, and a growing body of medical research, CDS allows clinicians to bypass volumes of information to access what they need, such as information on emerging medical breakthroughs and hard-to-predict health events. They can even drill down to nuanced details, such as precision dosing for specific medical conditions.
“Clinical Decision Support enables physicians to get answers to their clinical questions quickly at the point of care,” says Ted Post, MD, a nephrologist and Editor-in-Chief of UpToDate, Wolters Kluwer. “Clinical Decision Support helps build clinician knowledge through an editorial process that taps clinical experts who synthesize their understanding of the literature plus their clinical experience to provide evidence-based answers to those clinical questions.”
Bonis adds, “Physicians use CDS tools as part of their daily clinical routine across a variety of areas, including to help to solve complex clinical cases, justify admissions, confirm clinical decisions, assist clinical pharmacists in providing patient care support, and in treating unfamiliar conditions.” However, not all CDS systems are created equal. According to Bonis, CDS solutions must be backed by deep technology expertise and machine learning that allows organizations to do the following:
Share clinical information that is evidence-based, current, and highly trusted
Improve patient outcomes by removing variability and inconsistencies from one care team to another
Improve quality and patient satisfaction metrics. CDS helps your clinicians make consistent, accurate decisions that reduce length of stay, mortality, and readmission rates.
Keeping in step with breaking trends
“As providers continue to experience increasing burnout and numerous challenges, from staffing shortages to the COVID-19 pandemic, CDS technology has become even more essential in providing accurate patient information at the point of care,” says Bonis. For example, during the pandemic, when healthcare organizations and clinicians faced a new virus with little knowledge of its impact on patients, UpToDate, a CDS solution, quickly expanded to evidence-based guidance on 90 topics on the disease and refreshed more than 2,000 times to synthesize new learnings as quickly as they were being published.4
Creating consistency in an inconsistent world
CDS has also been indispensable for your clinical teams sharing information across growing provider networks, which puts them at risk for information gaps and care variations. As healthcare data grows and busy providers find themselves with less time at the bedside, healthcare organizations increasingly see the value in adopting CDS technology that enables your clinical users to search, locate, and review the information they need in as little as one minute. “Whether it's on a mobile device, or through the EHR or the internet, CDS technology has gotten much better and much more sophisticated,” says Bonis.
He adds that offering clinicians the best clinical evidence at their fingertips not only improves quality care and patient outcomes but also gives them more leverage to close information gaps in a rapidly changing healthcare space that is generating more healthcare data from new entrants into the primary care ecosystem. While Bonis is optimistic about the tremendous progress of CDS, he says that the global healthcare system faces more work ahead. “There is still a great deal of care variability, depending on who you see, where you're seen, how much insurance and social support you have, and numerous other factors. The challenge for the future will be to ensure that no matter where you're getting your care, you receive the most optimal care possible.”
[1] Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985 Oct;103(4):596-9. doi: 10.7326/0003-4819-103-4-596. PMID: 4037559.
[2] Blackman D, Cifu A, Levinson W. Can an electronic database help busy physicians answer clinical questions? J Gen Intern med 2002; 17Suppl1:220.
[3] Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med. 2012 Feb;7(2):85-90. doi: 10.1002/jhm.944. Epub 2011 Nov 16. PMID: 22095750.
