Minnesota Hospital Association

Quality & Patient Safety

Transforming Care at the Bedside

Transforming Care at the Bedside (TCAB) is a national program of the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI), two national quality improvement organizations. Its goal is to engage front-line hospital nurses and leaders at all levels of the organization to:

  • improve the quality and safety of patient care;
  • increase the vitality and retention of nurses;
  • engage and improve the patient's and family members' experience of care;
  • improve the effectiveness of the entire care team.

TCAB is different from traditional quality improvement efforts in that it does not come out of the executive office, but is a bottom-up approach that empowers nurses and other bedside caregivers to suggest, test and implement potential solutions to problems and find new ways to improve patient care.

The goals of TCAB are to increase the time nurses spend in direct patient care; to improve quality, reliability and safety of patient care; to create patient-centered care; and to improve nurse retention by improving workforce vitality. By achieving these goals, hospitals hope to reduce errors and adverse events and the results in Minnesota have been impressive. One or more participants have reported:

  • half as many falls;
  • increasing the number of patients triaged upon arrival to the emergency room from 58 percent in August 2010 to 98 percent in March 2011;
  • increased patient satisfaction scores; and
  • after putting TCAB in place, some teams have been able to raise the amount of time spent at the bedside to 60 percent.

A total of 50 Minnesota hospital units have participated in TCAB training — the most of any state in the country.

More time at the bedside

According to an article in the Rochester Post Bulletin, Olmsted Medical Center (OMC) is working to change the fact that, nationally, nurses only spend an average of 31 percent of their work time in direct patient care. Through TCAB, OMC aims to increase the amount of time spent at the bedside. Before TCAB, OMC identified that nurses spent 42 minutes per day hunting and gathering patient supplies, dealing with equipment that didn’t work and handling prescription problems. As of May 2011, OMC nurses had increased their bedside time to 57 percent on the day shift, 54 percent in the evenings and 37 percent during the overnight shift.

One example of a simple change that has made a big impact was described to the Rochester Post Bulletin:

“To send a specimen to the lab, you must use a plastic bag. The bags were kept in the nurses’ station. Now they’re kept in the patient rooms, eliminating the extra trip to and from the nurses’ station each time a specimen gets sent.”

 Another example of how TCAB has improved patient care is that in the past, nurses would leave a tape recorded message at the end of their shift describing how their patients were doing. Now, nurses introduce each other at shift changes and give reports together at the bedside.