It’s a fact of life on busy high-acuity hospital units. Routine patient care tasks, such as bathing and turning, can sometimes go undone when more immediate patient needs demand staff time. By assigning these tasks to specific patient care assistants (PCAs), some hospitals are ensuring that these tasks are consistently performed. In results coming from two pilot programs, the added bonus is that the remainder of the nursing staff can consistently complete the patient care responsibilities they are assigned—and patient satisfaction and outcomes improve.
The Advisory Board, a global research, technology, and consulting firm that helps hospital and university executives better serve patients, has issued a report that explains how some health care organizations are assigning specialized PCAs to manage only routine patient care responsibilities. This practice is not only proving highly effective in ensuring that routine patient care activities are completed, it is enabling all nursing staff to consistently complete the patient care responsibilities delegated to them without worry that some tasks might not be done. Thus, the reliability of the entire support team is improved. Because work is only being redistributed among existing staff, implementing these specialized PCA roles does not impact the budget.
The first step is to identify routine patient care activities—such as bathing or turning patients—that may not be done when unexpected, time-sensitive patient needs interrupt the workflow. These activities are then assigned to specific PCAs. It is important that these PCAs perform only specialized care and do not participate in other patient care activities because, if specialized PCAs are pulled away by other patient care activities, their ability to consistently complete the specialized work is jeopardized. To reinforce this requirement, specialized PCAs might begin their shift at a different time from their coworkers or post signs on patient room doors while they are providing specialized care to minimize disruptions. PCAs who are not assigned a specialized role continue to meet more immediate patient needs as they did before.
Health care leaders at Baptist Memorial Hospital-Memphis have trialed the use of specialized PCAs by creating a bath tech role. On each unit, two PCAs work together to bathe each patient. Baptist Memorial Hospital-Memphis reported improvements in pressure ulcer rates and patient satisfaction on the pilot unit—results that are especially attractive considering that they were achieved with no impact on the bottom line. In response to results returned from the trial, Baptist Memorial Hospital-Memphis is expanding the program throughout the hospital.
Health care leaders at the University of Pittsburgh Medical Center (UPMC) have also seen positive results coming from specialized PCA assignments. At UPMC, however, administrators identified several other routine patient care activities in addition to bathing that sometimes were not completed when PCAs were interrupted by unpredictable patient care needs. UPMC’s answer was to create two specialized PCA roles to ensure that both predictable and unpredictable patient care activities would be completed consistently. The first group, called “Reliable Rounders,” was charged with performing routine patient care activities such as bathing, turning, and rounding. The second group of PCAs, now known as “Variable Rounders,” continued to focus exclusively on variable patient needs, such as answering call lights.
As a result of this change, UPMC documented improved patient satisfaction scores regarding response to time-sensitive requests. UPMC leaders have decided to expand the specialized PCA roles systemwide. Like Baptist Memorial Hospital-Memphis, UPMC’s change in PCA roles was budget neutral. Assignments were shifted without necessitating additional staff.