Friday, February 22, 2013

The Quadruple Aim on Unit 36

I have the pleasure this year of being the GBMC Senior Team member who is assigned to Unit 36. Each of us on the Senior Team works with two units to narrow the gap between what the “front office” knows and what the “front line” knows.

Unit 36 is our Medicine/Psychiatric Unit. The Unit cares for people with mental illness who also have acute medical needs. The leadership dyad of Nancy Amann-Santos, RN, the unit manager, and Darin Lerner, MD, the medical director, are two of the most dedicated people I have ever met. Everyone who knows anything about healthcare knows how challenged our mental health system is. Nancy and Darin deal with this dysfunction everyday and they never lose sight of the reason why they and their Team are there…to deliver the care to their patients and families that they would want for their own loved ones.  But boy is it hard!

This morning I went to the Team huddle at change of shift at 7:15 AM. Nancy showed me the Team metric board that showed, among other things, recent hand hygiene audits that were at 100% compliance and many days of no patient falls with injury. I then listened while the staff debriefed on an incident where family members who were not associated with the same patient but who evidently knew each other, got into a verbal altercation on the Unit.

Trina Griffin, RN explained to the group how she had acted to deescalate the situation, avoid getting the patients upset, and get the visitors to act appropriately. The Team quickly brainstormed on other things that they could change to avoid this type of problem in the future. They then discussed two other patients: one who was admitted with a significant medical problem but who also had obsessive compulsive behaviors and the other who could not understand why it wasn’t safe for him to get out of bed by himself.

Working on an inpatient unit where the patients understand the care and are generally grateful is hard enough – dealing with the same issues in a population who does not always understand and who may take actions to harm themselves or others takes it to a whole new level. The Unit 36 Team comes to work every day to get to better health, and better care with less waste for their patients. You can feel their joy in knowing that what they do means so much to their patients and families, even if the patients….and sometimes the families…don’t always understand. I am very proud of them and very grateful for all that they do. 


  1. I went to the Schwartz Center Rounds when the staff of Unit 36 presented and I thought, "wow, our staff should hear this - it would give them a whole new perspective on what they consider to be "difficult" patients." I give a heartfelt salute to the men and women who work with this very difficult population. You are truly doing God's work.

  2. Dr Chessare, we do not have to go to unit 36 to deal with the challenges that the staff face in that unit. Take an elderly patient in a new environment, medicate them for their pain with a little dose of narcotics and here we get a challenging patient. In unit 36, nurses get 4 patients, the security officer is right in the unit, in the other units we deal with the same challenging situations and we get up to 6 patients. Thanks to all the staff who try to keep patients safe no matter how challenging they are.


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