Greg McVarish is the Health Services Manager for the General Medicine and Surgical Unit (3B) at Cape Breton Regional Hospital (CBRH), one of the SAFER-f pilot units in the Eastern zone. McVarish has worked for Nova Scotia health since June 2007, starting at the Valley Regional before returning home to work at the Cape Breton Regional in May 2008.
For McVarish, he highlights how the SAFER-f model at the unit level brings together all the people involved in patient care and care planning into daily bullet rounds. The bullet rounds allow the team to work collaboratively to ensure they meet the patient needs, communicate these with all care providers, and allow everyone to work towards the quickest, safest discharge. The goal is to get the patient home as soon as medically possible.
“Having been a Clinical Nurse Lead and working in Patient Flow in the past, I got to see how much planning goes into admitting patients and discharging them,” explained McVarish. “Part of my role was making sure they were going to an area that best suited their medical needs and ensuring that their discharge plan included all the proper resources and services in place for a safe return home.”
He brings this experience to his role as health service manager and the SAFER-f work on his unit. He says that this is a new way of thinking about a familiar concept, and initially it took some time to get resources and funding in place. Now that these issues are resolved, the team is really digging into implementing SAFER-f bundles, like bullet rounds. Being one of the first pilot units, McVarish credits his team and their enthusiasm from the director level right down to the unit staff with the project’s early success.
McVarish said that, since implementing bullet rounds, his team now discharges patients earlier in the day, which allows them to more quickly admit patients from the emergency department into their unit. This impacts the flow of patients across the entire hospital, reduces wait times for care, and contributes to shorter waits for Emergency Health Services in the Emergency Departments.
“All disciplines work together every morning in our bullet rounds. They are so helpful and open to this pilot program, including Social Worker Katie Young, Pharmacist Lauren Campbell, Dietician Sophie Lloyd, Physiotherapist Maureen Maillet-Miles, Occupational Therapist Jennifer Easterly-Krasowski, and Continuing Care Coordinator Stephanie MacDonald,” said McVarish. “They have basically become 3B staff members with their dedication to this project!”
McVarish said that the collegiality and cultural impacts of coming together regularly allows the entire team to feel comfortable providing input while creating discharge plans with the patient needs at the forefront.
“Our physician group are open and engaged participants in our bullet rounds,” said McVarish. “Additionally, Krista Smith and Anne Buchanan, both Directors of Integrated Health, are always available to offer any support they can. Also, our clinical lead Sarah Wagner was essential in educating staff and having them embrace this initiative, staff really accepted this as an opportunity to improve both our patient care and flow.”
Next steps for McVarish’s unit is to begin tracking both internal and external barriers for discharges to make the patients journey to return home more seamless.
“We will also be working towards establishing estimated discharge dates when admitted, so patient’s, their families, and all disciplines are on the same page with the treatment timeline,” explained McVarish. “We will also roll out new assessment tools for frailty, mobility, and delirium to get a better understanding of the challenges that exist while we work towards discharging patients from hospital.”