the majority of patients experienced less difficulty
voiding with the earlier catheter removal. For those
who did experience difficulty, there was more time for
interventions, enhancing an earlier discharge.
Patient Engagement
Engaging the patient in their plan of care can impact
outcomes associated with mobility, pain management
and discharge (Gwynne-Jones, Martin, & Crane,
2017; McCann-Spry, Pelton, Grandy, & Newell, 2016).
Patients are educated to request pain medication
prior to getting OOB and working with physical ther-
apy. During the pre-operative joint education classes
and immediately post-operatively, the probability of
discharge on POD 1 is discussed with the patient. All
disciplines make it a point to involve the patient and
family in goal setting and interventions throughout
all points in the TJR continuum of care.
OUTCOMES
Average LOS for TJR patients progressed from 4.85
days in calendar year (CY) 2011, prior to any inter-
ventions, to 1.82 days in CY 2017.
In CY 2013, 50% (n = 592) of patients were mobi-
lized on POD 0. Following implementation of the
standard for either a nurse or PT team member to
initiate mobilization on POD 0 in CY 2014, the per-
centage has progressively increased to 98% (n = 750)
in CY 2017.
During this same time period, the percent of PT
evaluations on POD 0 went from 30% (n = 592) in
CY 2013 to 98% (n = 750) in CY 2017.
The trend for patient satisfaction, evidenced by the
Press Ganey overall nursing score, is upward, begin-
ning in CY 2011.
DISCUSSION
A key factor in the success of this initiative was
interprofessional collaboration, particularly between
nursing and PT. Leaders from both disciplines role-
modeled partnership, communicated similar expecta-
tions and held their staff accountable. Willingness
of the PT staff to change their work hours to assist
in getting patient OOB on POD 0 sent a powerful
Issue 73, 2 2018 Pennsylvania Nurse 8
message of willingness to work together for optimal
patient outcomes.
Another success factor was engagement of the 30
nurses, 16 non-licensed assistive personnel and seven
PT staff. An initial tactic to gain this buy-in was
interprofessional education to these three roles,
focusing on the evidence associated with outcome
improvements. The unit nurse manager and educator
then appointed nurse champions on both shifts, who
met with them and PT leaders weekly. This group
discussed what was going well, as well as compliance
barriers. These discussions were then shared with the
entire staff, seeking their suggestions for ongoing pro-
cess improvement strategies. Night shift champions
were instrumental to project success by assuring all
patients were assisted to get OOB on POD 0.
Real-time and transparent data were also critical to
success. Length of stay, mobility and PT evaluations
on POD 0 were gathered, shared with all interprofes-
sional staff on a weekly basis, and necessary adjust-
ments made.
The upward trend in the overall nursing patient
satisfaction score could be perceived as related to
intervention tactics associated with decreasing LOS.
However, in June 2012, the same time clinical care
standards were starting to change, the orthopedic
unit was moved from an older building with smaller,
semi-private rooms to a new building with large,
private rooms. In addition, this new unit included a
PT gym area, with multiple options to prepare for
discharge, such as a model to practice getting in and
out of a car. These environmental changes could have
impacted patient satisfaction, along with the clinical
care changes.
IMPLICATIONS FOR CLINICAL PRACTICE
Partnerships between nurses and interprofessional
colleagues, as well as the patient and family, are
paramount to achieve optimal outcomes for patients.
All clinical care tactics described in this article were
driven by nurses and involved collaboration with PT
managers and staff, surgeons, and anesthesiologists.
Exemplary professional practice in Magnet® orga-
nizations is evidenced by effective and efficient care
services, interprofessional collaboration, and high-
quality patient outcomes (American Nurses Creden-
tialing Center, 2017). This organization’s journey to