Repurposing Fitbits To Track Improvement in Patient Care

A change in how nurses are assigned patients not only saved thousands of steps each shift but also led to a significant improvement in patient satisfaction on 17300 GYN oncology. When Martha Rahm came to the floor as clinical nurse manager in 2014, patient satisfaction scores were not where they should have been. “We were at 14.7 percent excellent for overall quality,” said Rahm, MBA, BSN, RN.

At the time, patient assignments were based on acuity, without consideration to location. A nurse could have patients at opposite ends of the floor. Two nurses could be assigned to separate patients in the same room. “When patients see a nurse, they sometimes make requests or have questions. If it is not your patient, you have to find their nurse,” said Rahm. “It was a lot of extra work for the nurses and it was confusing for the patients.”

In 2015, Rahm instituted two big changes – team nursing and geographical assignments. Two nurses and a patient care tech share responsibilities for eight patients. Assignments of those eight patients are based on location.

Nurses were skeptical. “We were afraid making an assignment based on the location of the patient on the floor would not give enough weight to how sick they were,” said Sarah Drake, BSN, RN.

To help her team see the difference, Rahm asked several nurses to count their steps using wearable activity trackers. Before team nursing and geographical assignments, they reported walking about 17,000 steps-per-shift. After the changes, the number of steps dropped to around 10,000 and patient satisfaction rose, as did teamwork scores.

In 2015, our overall quality scores reached 48.8 percent excellent.

Rahm reminds nurses their job is not a fitness program. “Our goal is to provide excellent patient care, do it efficiently and proactively and then we take care of ourselves,” Rahm said. “And it’s working.”


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Barnes-Jewish Hospital at Washington University Medical Center is the largest hospital in Missouri and the largest private employer in the St. Louis region. An affiliated teaching hospital of Washington University School of Medicine, Barnes-Jewish Hospital has a 1,800 member medical staff with many who are recognized as "Best Doctors in America." They are supported by residents, interns and fellows, in addition to nurses, technicians and other health-care professionals.

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