Signs point the way to improved patient care
Signs point the way to improved patient care
Visual control boosts productivity, reduces errors
Healthy hearts mark the yards for cardiac care patients exercising in the halls of St. Luke’s Episcopal Hospital in Houston.
A picture of a teardrop is placed on the doors of moms who have lost babies in childbirth, so all caregivers who enter know to respond appropriately.
Isolation signs have been redesigned to leave no misunderstanding about their purposes.
These innovative ideas all stem from the hospital’s visual control program which uses easy-to-understand signage cheat sheets with both verbal and pictorial instructions to communicate vital information to hospital staff and visitors. St. Luke’s has applied visual control throughout the hospital to boost productivity, reduce errors, and improve patient care. (See story on tips, right.)
"Every hospital should be doing this," says Duke Rohe of Management Consulting, formerly the hospital’s in-house consultant who introduced visual control to the hospital in 1991. "It’s one of those things where you ask yourself why didn’t we do this before."
The goal of visual control is to locate needed information as close as possible to the point of action. Typically, in hospitals when a question on procedure arises, employees have to dredge up a manual, search for the appropriate section, read it, and return to the site to continue their work. Others may not have time to research the procedure and must rely on their fallible memories, or they’re too lazy to bother looking for the manual. Visual control also helps communicate information to non-English speakers.
With visual control you don’t have people forgetting a step or saying well, no one told me,’" Rohe says. "There’s no room for presuming. When the sign is up there you can’t miss it."
Practicing visual control is ongoing. Staff are continuously looking around their work area searching for failures in three key areas:
• communication;
• standardization;
• adherence.
They note what information would facilitate those goals and put it on a sign. To ensure staff buy-in, employees should help design the signage, Rohe says. When designing signs, staff should make sure they protect patient confidentiality. They should not reveal a patient’s diagnosis. Recently, hospitals in California have been ordered to remove signs that violate this confidentiality. (See reader question, p. 21.)
At St. Luke’s staff members who spot new applications are publicly applauded.
Any department can apply visual control. At St. Luke’s, staff have pasted laminated instruction cards on laser equipment in the surgery unit, on fax machines in the office, and on the visitor’s daybed in the patient’s room.
One of the newest innovations is a redesigned isolation sign. On the old one, the word "isolation" was too small and could go unnoticed by visitors who may compromise care by entering the patient’s room. It also failed to explain what precautions staff and visitors needed to take.
The new sign does both. The front pictures a hand posed in the stop position, and the sign reads in bold letters "Staff and Visitors STOP: ISOLATION." On the back, a chart explains the standard precautions for three common isolation categories.
"We met with infection control to design this," Rohe says. "So far it seems to be going over well."
As this project indicates, implementing visual control costs little, Rohe says. "The signs are cheap; I make mine on my [computer]," he explains.
And it can save countless hours and dollars. "It’s hard to measure because it’s incremental, but there’s no doubt the savings is incredible," Rohe says.
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