Evaluation of Transforming Care at the Bedside (TCAB)

Results from the New Jersey Hospital Association Collaborative

About The Program

Transforming Care at the Bedside (TCAB) is a Robert Wood Johnson Foundation (RWJF) program designed to engage front-line staff in change processes to improve the work environment and the quality and safety of the care provided on hospital nursing units.

Launched originally in 2003 in partnership with the Institute for Healthcare Improvement (IHI), TCAB was implemented by the New Jersey Hospital Association’s Institute for Quality and Patient Safety (NJHA) in 52 healthcare organizations in the state. This collaboration was facilitated by NJHA from September 2009 through July 2012.

About The Evaluation

Marjorie Pearson, of RAND Corporation, led the evaluation team which used an observational, mixed method evaluation design to understand how hospitals implemented TCAB, how the work environment changed, how nursing outcomes changed, and if there was value to TCAB participation.

Two surveys of nursing unit managers and unit staff were conducted which asked about unit characteristics, improved performance, support and barriers, perceptions of TCAB’s usefulness and results, and future plans and expectations for TCAB. The survey of nursing unit staff assessed changes in teamwork on the units three times over three years.

Researchers collected administrative data that documented unit-level performance, including falls per 1,000 patient days, length of stay, and nurse satisfaction among other indicators.

Document collection and review allowed researchers to examine conference call minutes, call participation, webinar topics, and reports from participating units.

Knowledge and Impact

  • Pressure ulcer prevalence significantly declined, from an average of 3.39 ulcers per quarter at baseline to an average of 1.65 ulcers per quarter during the last measurement period.
  • Patient satisfaction with nurse performance significantly improved (p<0.05) in the domains of respect and careful listening.
  • 90 percent of unit managers perceived improvement in the safety, patient-centeredness, and efficiency of the care provided on the unit.
  • 56 percent of unit managers cited insufficient staff time as a significant or moderate barrier to implementation.
90%

of unit managers saw improvements in safety, patient-centeredness, and efficiency of care during #TCAB

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