Issue link: https://digital.copcomm.com/i/1130164
14 Working Nurse l WorkingNurse.com June 10–July 15, 2019 MY SPECIALTY by Keith Carlson, RN, BSN, CPC, NC-BC Tell us about your nursing career. My mother lost a battle with breast can- cer at age 46. I had basically lived with her in the hospital for two months to serve as her advocate, so my aunt urged me to consider becoming a nurse. My first nursing job was at a Veterans Administration hospital. After two years, I became a charge nurse, took a critical care training course and went on to work in cardiac critical care. I worked at a critical care medical ICU at a VA facility in Connecticut for 16 years. I also did various travel assignments, became a rapid response nurse at a Planetree facility and worked in general ICU in Texas for a few years. My husband is from the Dominican Republic, so I also worked for a time as a consultant for a hospital in Santo Domingo, helping them prepare for Joint Commission International accreditation. It was a wonderful and challenging expe- rience, since even the most basic things were not really standardized. What is your current role at Keck Medical Center of USC? Our Value Improvement Office started the clinical improvement fellowship in 2017. It's an opportunity for a clinician to engage with administration in a unique way to bridge the gap between hospital leaders and frontline providers. It sound- ed very interesting, so I dove into the role in July 2018. I spend two-thirds of my time as a clinical improvement fellow while main- taining one clinical shift per week. This allows me to continue engaging in direct patient care, maintain my clinical skills and bring what I'm learning back to my colleagues at the bedside. I work mostly in the Care Delivery Redesign (CDR) pod. When I first start- ed, it was all new to me. I didn't know much about the business of healthcare, data transparency or the strategy and planning behind creating improvement and change, so it was challenging at the beginning. Based on my clinical expertise and interests, I joined the Enhanced Recovery After Surgery (ERAS) project. Our seven-person, interprofessional ERAS team works to standardize care for surgical patients across clinical path- ways, including pre-habilitation, optimal pre-surgery nutrition, multi-modal pain management, early mobilization and minimizing tubes and wires. Overall, our goal is to help improve patient and family experience, encourage opioid-sparing techniques, decrease vari- ation and reduce lengths of hospital stay. How did you learn by observing the patient journey? Some of our most valuable insights come through gemba kaizen, a Japanese methodology that stresses examining firsthand where the work takes places (the gemba) to look for opportunities for improvement (kaizen). This methodolo- gy came out of manufacturing [Editor's note: It was first developed in the 1930s by Toyota!], but it can be used in many different industries. By observing the patient journey, we discovered that only a small percentage of patients adhere to their pre-surgical instructions. We believe that this is not a matter of noncompliance, but rather of lack of consistency and quality of preop- erative patient education. Therefore, we concluded that we could have a profound impact on our goals by improving standardized patient Robin Krasner, RN, BSN, CCRN Clinical Improvement Fellow Value Improvement Office Keck Medical Center of USC Clinical Improvement Fellow Evaluating processes to improve care delivery A GROUP EFFORT Above left: Krasner (second from right) poses with five of the six other members of the ERAS team (left to right): clinical nurse specialists Eugenia Chong, RN, MSN, AGCNS-BC, PCCN, and Kathrine Winnie, DNP, AGCNS-BC, CCRN; Michael Kim, D.O.; data analyst William Widjaja; and program administrator Snow Sun (far right). Above right: ERAS is only one of the projects of the Care Delivery Redesign pod, which also includes performance improvement analyst Jason Willardson, MHA, and program director Carey Li, MPH, CSSBG, CPXP, as well as Krasner and Eugenia Chong (right). Not pictured: Lindsay Lawrence, MHA. Care Delivery Redesign pod members ERAS (Enhanced Recovery After Surgery) core team