I've seen many approaches to "getting the job done" in unit-staffing conferences. Some seem to be a good idea in concept, but lose something in the translation. Bunches of providers gather on a unit and a nurse convenes the meeting by lugging a kardex into the room and starts reading off the first kardex and goes straight down the list. Usually statements like, "Mr. Green is doing well today...and is still here... I don't know why the oxygen is still on...."

This seems inconsistent with the requirements in healthcare today. Today a sense of impatience, and urgency need to infuse this unit-staffing conference. The skill set used to accomplish an hour of patient information exchange should use different ground rules. In order to get return on the investment of this meeting, try some of these ideas:

1. Come to talk. Even if a provider does not know all the details of the patient, get caught up. Ask questions, do not presume everyone else knows the situation either. There are lots of changes in a day.

2. Prioritize the patient presentation. The energy in the group is best in the first few minutes. Present all patients who have been in the facility more than 3 days, if the average length of stay is 5 or 6 days. This gets the power up on the patients' who will be the problems soon. One of two things will happen, it will be determined that they are rightfully there, or they will be managed today.

3. Be sure there are plenty of phones in the room. There should be two or more phones ready for use as the team meets. It is essential that questions are answered now. Work with the synergy of the moment, if delayed - it won't be as likely to happen. Take action now and call for the study result, don't wait for the paper to make its way to the floor. For example: Call radiology, get the result, call the doctor and get the drug order, change the IVs to PO and if needed, get the discharge order.

4. Get the paperwork done. There are always entries to be made in the patient record. Documentation in the patient education form, or interventions to add to the patient plan of care. While the providers are around the table, pass the forms around and get them updated. Use this time to capture the interactions with the patients that just occurred by the providers and the actions that are taking place in the room. This will avoid having the providers leave the room after the hour meeting and have to hunt down the chart and make the entries. Make every minute count.

5. Get physicians and other staff involved. Put the facility on notice that between 2:00 and 3:00 pm things will be happening. In that "action hour" they will be called upon to provide reports and support to the patient. This is the spirit of rapid cycle improvement. The whole organization supports this process. Test it, challenge the departments like radiology, laboratory to be the virtual members.

6. Action oriented approach. Cream rises to the top. As others realize that decisions are being made and things happen in this group, others will be attracted to the group. Consider moving to more, frequent, shorter meetings each week. Always have a Thursday meeting. This avoids the Friday rush for weekend loose ends.

7. Come prepared. Know or learn payment schemes. What is reimbursable? What is the difference between transfer of patients to long term care and pure discharge in payment? Are there physician incentives to keep the patient in the hospital? Dollars and days saved can be equated to poor quality so make knowledgeable decisions. It is a given that staff usually does not know how reimbursement occurs, learn together.

8. Keep a record. As the team identifies patient strategies that smooth seams between departments and sites, write them down. Soon the trends will emerge that show predictability in the system. No need to reinvent the wheel. Get to know the good contact people in facility departments or outside agencies. The team will also know how to trouble shoot excessive report times and certain physician patterns of care.

9. Make "integration" a core value. Insist on reviewing care together. Share information from the patient's initial data base to the discharge instructions. Pledge to reduce duplication of documentation by documenting together. Overcome barriers, write on existing common progress notes or a form created expressly for that purpose. Remember - the patient on ICU or on the Medical unit is more intensely ill than ever, so make the information the same in both places.

The support departments, respiratory, social work, and others can more easily follow patients progress if the whole form retains continuity. Nursing and other staff are being cross trained and learning multitasking, such as nurses giving respiratory treatments. Therefore, remove the barrier of separate nursing forms and respiratory forms and benefit from having the respiratory grids in a common record where respiratory treatment is the focus, not who is giving it.

Swain & Associates offers workshops detailing the Fraud and Abuse issue. For more information call 1-800-843-6449 or E-mail us at Info@SnAConsulting.com.