The center of the Primary Care Team model is the nursing team, which is typically comprised of an experienced RN care manager, an RN or LVN provider and a clinical assistant (CA). The primary care team shares the responsibility of providing care for an assigned group of patients, and each member of the team has a clearly-defined role.
The experienced RN care manager leads the team and is responsible for mentoring, making patient rounds and assignments, and making intra-shift adjustments based on real-time patient needs. The RN care manager provides oversight as needed, especially during the initial assessment and discharge planning process as well as providing direct patient care. The RN or LVN care provider provides direct patient care and helps mentor the CA. And the CA completes basic nursing tasks and assists the other team members.
In addition to defining the roles of the staff comprising the Primary Care Team, the model defines the nursing team’s role relative to the department’s case manager. The case manager is responsible for the “plan for the stay,” addressing questions such as “how long will the patient probably be in our unit?” and “What must be accomplished before the patient is ready for a different level of care or discharge?” The RN Care Manager is responsible for the “plan for the day.” This perspective is brought to shift report to ensure that the team is tracking the patient’s progress toward discharge and is accomplishing the necessary work each day to ready the patient for discharge at the appropriate time.
The team approach helps free up time for the experienced nurse, who is now able to do rounds with physicians which improves the nurse’s efficiency with following any new physician orders as questions can be answered real-time. RNs also place question sheets on the front of patient charts for physicians to enable more efficient communication between physicians, patients and staff.
Based on the principle that every team member is fully utilized and supported, the RN care manager receives support from above by a unit manager or charge nurse, laterally by a case manager, and from below by fellow team members.
Seton encourages the use of focused team meetings to review workloads and patient needs. Primary Care Teams in some units use “Take 5 for Safety” huddles. Scheduled twice during each shift, huddles are quick, standing team updates on patients, designed to convey the most pertinent information. The “Take 5” huddles review any ‘red flag’ information that might help clarify exactly what to watch for in a patient’s assessment or re-assessment and pertinent information about working with the family.
This model of “intentional conversation” was included in the PCT model in order to reinforce the concepts of teamwork and patient safety. After the model had been implemented with team huddles recommended at least twice per shift, the IOM report on patient safety and recommended patient safety goals was published. The IOM report promoted team meetings twice per shift as a way to support patient safety during very busy and often chaotic shifts.
Other units use a status board as means of real-time communication. The names of the care teams are on a whiteboard. Every two hours, each team updates its status: green means the team is good, can help others and take admissions; yellow means okay, but unable to take extra admissions or patients at this time; and red means the team needs help. The board can act as a substitute for a huddle as it is easy to see when a team needs help and who can help them.
The team actively involves the patient in her or his care planning; every patient on every shift is asked, “What is the most important thing I can do for you this shift?” By asking patients what they need today, nurses can leave the hospital feeling fulfilled, knowing that met an important need from the patient’s perspective. And a lot of the time the requests are small things that volunteers and CAs can easily do.
In addition, each member of the team uses “Back to Basics” caring behaviors, which include introducing her/himself and patient care role, calling the patient by her/his preferred name, and using direct eye contact and physical touch when talking with patients.
