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As a quality review tool, Hope Hospice in Fort Myers, Florida, measured the number of visits by different nurses. The group uses its database to track which health care providers have visited a patient and what services were provided. Hope Hospice then uses the reports to review continuity of care. The hospice teams also review data about unscheduled visits, which may indicate uncontrolled symptoms, a fall, or some other crisis. If three or more nurses see a patient in any week, the quality review team looks into why this happened: Was there a set of special services that required a different nurse at morning, noon, and night? Or did staffing problems mean that the three nurses were chosen willy-nilly?
The team found that once it kept the number of different professionals visiting a patient to a minimum, continuity was more easily maintained. The group found that continuity influenced patient satisfaction. For example, one care team had many nurses and health aides seeing patients; and, at the same time, morale was low and complaints were high. After the Breakthrough Series team coached its colleagues on how to plan staffing needs, the caregivers reported feeling better about their work, and patient complaints subsided.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved. For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ]. |
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