How Can You Walk Less and Gain Time on the Medical-Surgical Floor?

Nurse working on the medical-surgical floor

From room to room and hall to hall, you respond to many different needs on the medical-surgical floor. Competing priorities may divide your attention and require you to be in multiple places at once.1 As a result, you’re almost constantly moving. In fact, nurses usually spend no more than 30 seconds in a single location.2

You may walk up to five miles per shift while managing tasks such as alarms, coordinating care, and looking for supplies.2 You work hard to make every step count, but up to ten percent of your shift can be consumed by breakdowns in internal supply chains.3 Interruptions not only waste time; they can also affect quality of care.5

There’s good news. Every day, medical-surgical clinicians are using smarter workflows and technologies to help them reduce interruptions and save time on the wards.6 They’re using wireless monitoring and clinical decision support systems to help manage competing priorities.4 They’re reducing response times and improving care.4

In this blog post, we’ll examine how physical space can present a challenge for working efficiently on the medical-surgical floor. Let’s take a guided walking tour of the medical-surgical floor to see where your time can get lost, and how you can reclaim it.

First Stop: Patient’s Room

Taking care of patients is likely why you decided to work in a hospital. But when you visit a patient’s room, you’re frequently interrupted.1 And that takes time away from your patients.

For example, a nurse’s attention can be derailed by the simple fact that rooms lack enough electrical outlets.3 What if a computer station on wheels blocks the sink because the only electrical outlets available are located above the sink?3

Other physical annoyances can interrupt a nurse’s workflow as well. A lack of space or cluttered layout can make it challenging to move a patient or complete other bedside tasks.7 Nurses in one study reported a total of 2,391 operational failures.7 Of those, 15.1 percent were attributed to floor layout.7 Other studies have implicated insufficient workspace as the underlying reason for 29 percent of clinical interruptions.3

But before you can devote all your attention to the patient on your first stop, you realize that you urgently need an IV pump. Now it’s off to the supply room.

Related: Mobile technology can help you manage priorities while on the move. See how.

Second Stop: Supply Room

Nurses cite equipment and supply problems as the most common reason for operational failures (interruptions caused by lack of supplies or information).7 Each operational failure can take an average of 3 minutes to address.3

In total, nurses spend an average of 30 minutes of every shift tracking down equipment.4 In one study, nurses experienced a total of 120 operational failures, of which space and equipment insufficiency comprised 11 percent.3 Furthermore, nurses can spend up to 25 percent of their time looking for other staff members.1

Operational failures not only waste valuable time — delaying care by as much as 5.5 minutes – they can contribute to burnout and negatively affect patients.3

But tracking devices can help. Locating systems enable clinicians to find equipment, staff, and patients.4 After one hospital tagged its equipment with tracking technology, it reduced daily search time by 96 percent – from four hours to ten minutes.8

Related: Explore time-saving innovations that can help you improve care. Visit the resource site.

Third Stop: Central Workstation

Walking to the nurse’s station can take up to 58 minutes each day.4 When you can spend less time walking, you can spend more time on patient-care activities, like responding to alarms that may be life-threatening.

One hospital in West Virginia decided to speed up the process of patient discharge by installing touch-screens at multiple stations.4 In this way, nurses could update a patient’s status at the point-of-care, without having to drop off a patient’s chart at the front desk, which could cause significant delays in discharge.4 The new system shaved 30 minutes to an hour from the discharge process.4

And after a hospital discharges a patient, the patient’s room needs to be cleaned. Instead of requiring nurses to walk by rooms to observe which ones needed housekeeping, one hospital used flat-panel displays to alert service teams.4 The new system reduced calls to the housekeeping supervisor by 50 percent and calls back to the bed manager nurse by 20 percent.4

Nurses spend a large portion of their time at the nurse’s station. In one time-motion study, busy medical-surgical nurses spent only 2.8 percent of documentation time in the patient room, compared with 80.6 percent at the nurse’s station.2 But mobile devices can reduce the time spent on charting by 25 percent.4

Related: See where time gets lost on the medical-surgical floor. View the infographic.

Fourth Stop: Patient’s Room

You’re finally back in a patient’s room. Studies have shown that nurses only spend about 37 percent of their time with their patients,9 or 9 minutes with each patient per shift.10How can you make that time spent at the bedside more efficient?

Clinical decision support (CDS) systems and wireless monitoring can help you manage patient needs from wherever you are. Remote monitoring can help reduce call response times and falls, length of stay, and hospitalization by up to 80 percent.11,12 In one hospital, wireless monitoring helped nurses save 4.4 percent of time spent on administrative tasks, and more time on patient care.4

Related: Remote monitoring can help you track patient conditions even when you’re many steps away. Learn more.

Fifth Stop: Pharmacy

Nurses walk between one and five miles each 10-hour shift.2 Some of that distance can be accounted for by treks between the hospital pharmacy and patient rooms. And of course some medications need to be taken with food, so that involves a short walk to the unit refrigerator for applesauce.3

Delivery robots can help technicians avoid time-consuming trips related to patient medication.4 One hospital tasked three robots with deliveries of medication and routine supplies.8 The units served by the robots were able to save 4.5 to 7.5 hours every day in clinician time.8

As an added bonus, delivery robots do not require any structural changes in a hospital layout.4 They can be programmed to evade obstacles, and even use the elevators.4

Related: Explore more ways technology can buy you more time at the bedside. Visit the resource site.

Sixth Stop: Supply Room

You’re back in the supply room, this time looking for a syringe. You’re calculating the minutes it will take to call central supply to have the missing items sent up, and you’re feeling frustrated.

Unfortunately, up to 90 percent of clinical have consequences for patient care.5 But your medical-surgical floor can apply the science of saving time to clinical workflow, and help improve outcomes for the patients under your care.

Related: Find out how smarter spaces can contribute to patient care. Visit the resource site.

References:
1. Tucker AL, Spear SJ. Operational failures and interruptions in hospital nursing. Health Serv Res. 2006;41(3 Pt 1):643–662.
2. Hendrich A, Chow MP, Skierczynski BA, Lu Z. A 36-hospital time and motion study: how do medical-surgical nurses spend their time?. Perm J. 2008;12(3):25–34.
3. Tucker A, Heisler W, Janisse L. Organizational factors that contribute to operational failures in hospitals. Published Sep. 4, 2013. Harvard Business School Website. Accessed Jan. 29, 2018. 
4. Turisco F, Rhoads, J. Equipped for Efficiency: Improving Nursing Care Through Technology. Published Dec. 2008. Accessed Jan. 29, 2018. California Health Care Foundation Website.
5. Monteiro C, Avelar AFM, Pedreira M da LG. Interruptions of nurses’ activities and patient safety: an integrative literature review. Rev Lat Am Enfermagem. 2015;23(1):169–179. doi:10.1590/0104-1169.0251.2539.
6. Gordon JE, Deland E, Kelly RE. Let’s talk about improving communication in healthcare. Col Med Rev. 2015; 1(1):23-27. 
7. Stevens KR, Ferrer RL. Real-time reporting of small operational failures in nursing care. Nurs Res Pract. 2016;2016:8416158. doi:10.1155/2016/8416158.
8. Wicklund E. Study: RTLS technology can save hospitals time and money, boost care. Published Nov. 17, 2009. Accessed Jan. 29, 2018. HealthcareITNews Website.
9. Westbrook J, Duffield C, Li L, Creswick N. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Services Research 2011; 11:319.
10. Tipping MD, Forth VE, O'Leary KJ, et al. Where did the day go? A time-motion study of hospitalists. J Hosp Med. 2010;5(6):323–328. doi: 10.1002/jhm.790.
11. Agboola S, Jethwani K, Khateeb K. Heart failure remote monitoring: evidence from the retrospective evaluation of a real-world remote monitoring program. J Med Internet Res. 2015;17(4):e101. doi:10.2196/jmir.4417.
12. Hale TM, Jethwani K, Kandola MS, Saldana F, Kvedar JC. A remote medication monitoring system for chronic heart failure patients to reduce readmissions: a two-arm randomized pilot study. J Med Internet Res. 2016;18(4):e91. doi:10.2196/jmir.5256.

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TOPIC: Vital Sync™ Remote Monitoring systemsMicrostream™ Capnography, Medical-Surgical

About the Author

Melissa Worthington

Melissa Worthington is a clinical product specialist at Medtronic specializing in Microstream™ capnography, Nellcor™ pulse oximetry, and Vital Sync™ Remote Monitoring systems. She was previously an adult cardiac/labor and delivery RN in Columbus, Ohio, and a keynote speaker at Respiratory Therapy Symposiums in Dayton, Ohio.

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