Fairview Health Services, based in Minneapolis, in 1999 began developing a strategy to bring clinical documentation to the next level and unite disciplines around interdisciplinary, evidence-based content.
Addressing the problem of discontinuity was a key objective in the effort. Nurses often face what Thomas R. Clancy, Ph.D., RN, Clinical Professor in the School of Nursing at the University of Minnesota, calls “compression complexity”, or the need to respond to anticipated events while handling multiple responsibilities — all within a highly condensed time frame.
Such multi-tasking is often the cause of medical errors, inefficiency and waste, according to Dr. Clancy, who documented his findings in “Improving Patient Safety, Increasing Nursing Efficiency and Reducing Cost through Technology Supported Pull Systems,” published in 2010.
After discovering that the time required to complete inter-shift or professional exchange reports (PER) varied greatly among nursing units (from 40 minutes to more than an hour), Fairview nursing leaders launched a program to reduce end-of-shift compression complexity. To understand the working of the PER process on nursing units, nurse leaders entered into a collaborative study with the University of Minnesota School of Nursing and The CPM Resource Center. The CPM Framework brought with it a process and format for PER that has evolved through the years by leveraging key patient information from the clinical documentation system.
Survey results revealed that nurses completing a PER focused on patient assessment, signs and symptoms, and impending orders, but limited discussion of progress toward goals, integration with interdisciplinary team members and nursing orders, and discharge needs.
From this study, a new process emerged that incorporated an understanding of the patient story and included documentation throughout the day, the “pulling forward” of meaningful patient information, updates by each disciplines and information transmittal to a new shift. It also revealed that nurses who leverage a framework for coordinating and documenting care produced a professional exchange report (PER) cycle time that was 62 percent more efficient than a typical medical/surgical unit. In addition, the nurses enjoyed a 29 percent improvement in PER effectiveness survey scores.
