A New Era in Nursing

Transforming Care at the Bedside

With so much care being delivered in hospital medical-surgical units, and with an estimated 35 percent to 40 percent of unexpected hospital deaths occurring on such units, the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI) agreed to work together to create, test, and implement changes to dramatically improve care on medical-surgical units, and improve staff satisfaction as well.

In 2003, through an initiative called Transforming Care at the Bedside (TCAB), RWJF and IHI created a framework for built around improvements in four main categories:

  • Safe and Reliable Care
  • Vitality and Teamwork
  • Patient-Centered Care
  • Value-Added Care Processes

Over the course of several years, participating hospitals tested, refined, and implemented change ideas within each of the four categories, many with very promising early results. Examples include the following:

  • Use of Rapid Response Teams to “rescue” patients before a crisis occurs
  • Specific communication models that support consistent and clear communication among caregivers
  • Professional support programs such as preceptorships and educational opportunities
  • Liberalized diet plans and meal schedules for patients
  • Redesigned workspace that enhances efficiency and reduces waste

Many changes could not be strictly categorized, but produced positive change in one or more categories. IHI believed that by working in all four categories simultaneously, care teams could more effectively transform results.