Applying Inpatient Experience to Ambulatory Clinics
VCU Health is an integrated health care system in Richmond, VA. The system includes VCU Medical Center, the Children’s Hospital of Richmond (CHoR), and numerous ambulatory clinics. 77 VCU ambulatory clinics are now enrolled in TCPI; 65 of those are specialty practices.
In 2014, VCU created its first Advisory Council at the Medical Center; 15 patients and families were members. Four years later, over 45 patient and family advisors serve on seven active PFACs as well as on five hospital committees in the system. Because of this strong inpatient history, VCU staff members who lead TCPI efforts for the ambulatory clinics have been able to align their goals and strategies with the organization’s existing commitment to patient and family partnerships. An identified priority for ambulatory care is to embed the patient and family voice into transformation work.
There are now three PFACs specifically for ambulatory care: the Complex Care PFAC, the Cancer Care PFAC, and a recently launched Ambulatory PFAC. A current project of the Complex Care PFAC is exploring ways to increase the use of advanced directives in three ambulatory clinics. The new Ambulatory PFAC is charged with issues that span all practice sites in the system, e.g., providing input on the design and construction of VCU Health’s new ambulatory building.
The Family Advisory Network (FAN) of the Children’s Hospital of Richmond (CHoR) is another example of successful integration of families in the VCU Health system. Created in 2016, the FAN is actively involved in issues related to both ambulatory and inpatient programs for children and their families. Additionally, five parents from the FAN serve on quality committees for pediatrics.
Input from the Family Advisory Network has resulted in positive change in several areas, including:
- Design of the new outpatient Children’s Pavilion:
- Selection of artwork for the space
- Improvements to the restrooms and handicap access
- Changes to improve the care experience and reduce anxiety for children undergoing MRIs, including:
- Identifying themes for each space
- Wrapping the MRI machine with an image appealing to children
- Offering virtual reality goggles for older children during scans. (In one week alone, 14 MRI cases scheduled for sedation did not need it because of the use of goggles.)
- Availability of Child Life staff during scans
- Sepsis protocols (for ER and inpatient services)
- Addition of a parent as a member of the Sepsis QI committee
- Development of systems to enhance communication between the health care team and families, including scripts for staff
- Implementation of a standard approach to early sepsis identification and prevention
The following key factors have contributed to VCU Health’s successful partnerships with patients and families:
- Commitment of leadership to support partnerships with patients and families, e.g., CEO’s presence at PFAC meetings, allocation within administrative budget for PFACs
- Ongoing leadership to support and mentor patients and family advisors on committees
- Development of patient and family leaders who can identify new members and mentor them
- Continuity of a PFCC Coordinator who can share lessons learned with PFACs across the system and support the onboarding and placement of advisors in meaningful positions
- A strong experience with PFACs and other partnerships in inpatient settings that can be applied to ambulatory settings