Transforming Care at the Bedside
Building Local Capacity for a More Sustainable Model of Improvement
Background & Goal
Frontline nurses working in interprofessional teams in complex environments are poised to identify and implement processes to improve quality of care. Transforming Care at the Bedside (TCAB) cultivates leadership and provides tools to empower nurses to contribute to significantly transform the health care system.
Transforming Care at the Bedside – or TCAB – is a learning collaborative that engages nurses and other frontline healthcare staff in generating and testing ideas that can lead to practices and processes that are more consistent, efficient, safe, and patient-centered.
Since 2003, when The Robert Wood Johnson Foundation and the Institute for Healthcare Improvement developed Transforming Care at the Bedside, the curriculum and training has been available to hospitals with many organizations embracing TCAB and spreading the process to other units and departments. In 2009, efforts were initiated to implement TCAB in a more concentrated way through regional and statewide efforts. By mid-2011, a total of 181 hospital teams in 7 regions across the country including, Maine, Minnesota, New Jersey, New York, New Mexico, Oregon, and Wisconsin, were actively participating TCAB.
The Regional approach employs a Regional Clinical Leader who is responsible for the management of the day-to-day TCAB activities, and supports the teams through monthly conference calls, coaching and site visits, and web-based resources. With the regional proximity, participating hospital teams can efficiently use their resources, promoting collaboration within the community. This model further reinforces sustainability and spread, with the supporting resources and knowledge accessible and existing within the region.
Evidence of Success
- Hospitals involved in TCAB have improved patient safety through reducing medication errors.
- With the implementation of the medication safety zone, a hospital in Maine improved patient safety by decreasing medication errors in one year by 70% from 20 to 6.
- A Minnesota hospital decreased medication variations from 72% per month to 23% in just 2 months.
- TCAB has spread beyond medical-surgical units.
- A hospital team in Wisconsin has spread TCAB collaboration beyond their pilot unit with involvement from Nutrition Services, Social Services, Physical Therapy, Occupational Therapy, and Respiratory Therapy.
- Maine’s Regional TCAB launch included a skilled nursing facility.
- One New Jersey TCAB team includes The Visiting Nurse Association of Central New Jersey with a 10-nurse team.
- Many TCAB teams have focused on patient and family care and have improved their patient satisfaction scores.
- Examples as they relate to HCAHPS scores include:
- scores related to prompt staff response to call button increased from 40% to 90%;
- well-controlled pain score improved from 63% to 68.8%; and
- staff addressing pain score improved 70% to 81.3%.
- Hospitals investing in TCAB have reported significant cost-savings.
- A Western New York hospital has experienced cost savings hospital-wide. Experiencing an increase in team vitality through TCAB, the TCAB unit maintained no nurse turnover for eight consecutive months. As a result, the hospital estimates cost savings of $240,372.
- Another hospital in Western New York hospital reported a 67% reduction of Hospital Acquired Pressure Ulcers, estimating cost savings of $880,000 - $1,540,000.
- Through the implementation of team admissions, one team in New Jersey reduced incidental overtime by 30 hours per month.
New Transforming Care at the Bedside Virtual Resource Center