Hospitalist Medicine — Unit 74

74 MS is a 36-bed Medicine unit, which primarily cares for Medicine Hospitalist patients. We are located on the 7th floor of the North Tower. The unit has 24 total rooms that can accommodate 36 total patients. Out of the 36 total rooms, 12 are private rooms and the rest are semi-private rooms. We have two negative airflow rooms that can accommodate respiratory isolation needs. The unit has the capability to monitor patients on continuous pulse oximetry. We have an occupancy rate of 94%.

Description of Patient Populations

Patients admitted to unit 74 are medical patients requiring in-patient hospitalization and care. The unit primarily serves the patients of the MHS service (Medicine-Hospitalist) and serves as a backup for the other medicine services (MIN, MGI, FAM, MGO, MOR, MGR, MBL, MTS). Patients admitted to the unit comprise unit-unit transfers from the intensive care units or the intermediate care units, lobby admissions, Emergency Department admissions, and hospital-hospital transfers. Common diagnoses include (but are not limited to): Chronic obstructive pulmonary disease, acute coronary syndrome, diabetes, pneumonia, sickle cell, urinary tract infections, bacteremia, acute myocardial infarction, etc.

Nursing Care

Nursing care is focused on the assessment, diagnosis, planning, intervention, and evaluation of the medical patient from admission to discharge. Emphasis is made on the holistic delivery of care and focuses on the importance of a head to toe assessment. Patients and families are given emphasis as recipients of education and teachings as well as their collaboration in the delivery of their care. Nursing activities comprise of: pain control, ambulation and/or physical activity (ROM-active or passive), provision of nutrition through assistance of feedings or through parenteral or enteric feedings, infection control, administration of medications, management of drains and tubes (Duvall, JP, VAC, GT, NGT, chest tubes) and skin care.

Health Care Team

The MHS service is centrally located in units 74 and 75 under the leadership of Nila Radhakrishnan, M.D. The emphasis is on a collaborative approach in the progression of care with the intent of decreasing length of stay and improving patient outcomes. Multidisciplinary collaboration is emphasized between the nurses, physicians, social services, rehab services and nutrition services with the intent to safely plan and progress discharge planning at the time of admission leading to the day of discharge. Inter-disciplinary resources that are available on unit 74 include: Respiratory Therapists, Physical and Occupational Therapists, dietitian, WOCN nurses, rapid response team staff (STAT nurses), Patient-Family Services, IV nurse, and Pastoral Services.

The management team comprises of the Nurse Manger, and the Clinical Leader, with support provided by the Unit Assistant under the supervision of an Associate Vice President of Nursing Services. The Nursing staff is provided with opportunities for training and learning experiences to enable competency as defined by the role in the job description and departmental education plan. There is an emphasis towards advancement of degrees as well as national certifications. Nurses and patient care assistants (PCA) provide direct patient care while the support tech provides both clerical and mobility/ambulation support.

Staffing Plan

Nursing care on 74 MS is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care) with co-worker assistance. The PCAs are assigned patients under the direct supervision from the nurse. Clerical coverage (support tech) is available 24/7. Maximum patient assignment per nurse is 1:6 on both day and night shifts. The charge nurse (CN) oversees bed placement, staffing assignments, is available to offer assistance for daily operations, acts as a resource and monitors staffing numbers. The CN is also able to provide assistance in the provision of care. The skill mix of the staff working on the shift as well as the level of experience and expertise is considered by the CN prior to filling in the shift assignments. Patients requiring sitters (1:1 observers) for violent or non-violent reasons & Baker/Marchman Acts are coordinated thru the Central Staffing Office. The staffing plan is based on a budgeted acuity of 1.52, HPWI of 5.99, HPPD of 11.35 with a skill mix of 70/30.

Additional considerations for staffing include:

  • Complexity of the patient’s condition (frequency and length of time for procedures, physical care needs) which are reflected in the Quadramed system
  • Relevant safety and infection control issues
  • Assignment from the previous day to insure continuity of care
  • Central staff/float staff assignment to be altered due to their competency or skill level
  • Patient transport requirements

Requests for scheduled time off are reviewed on a case-to-case basis taking into consideration the staffing needs of the unit. Requests are granted if staffing numbers do not compromise patient safety and that coverage is maintained without incurring overtime.

Staff attendance at meetings, education offerings, and other activities are coordinated through the management team ensuring patient care coverage is adequate and continuous.

Reviewed & revised: 01/2021