Project Option 1.9.1 Expand Specialty Care Capacity: ESTABLISH NURSE RESIDENCY AND SIMULATION LAB
Unique Project ID: 138951211.1.6
Performing Provider Name/TPI: The El Paso County Hospital District d/b/a University Medical Center of El Paso (UMC) / TPI: 138951211
Project Description:
Under this project, UMC El Paso will develop, implement, and evaluate a comprehensive nurse residency program at UMC El Paso for nurse techs and graduate nurses.
Under this project, UMC El Paso will develop and implement a nurse tech program for nursing students seeking employment after completion of their 6th semester from accredited schools of nursing within the community. This program will assist these students in transitioning from academia to employment in an acute care setting. UMC will evaluate the current preceptor program; this evaluation will include the revision and improvement of the curriculum which is used to assist preceptors assigned to graduate nurses.
UMC will also develop and initiate an evidence-based nurse residency program at UMC. This program will include the nurse tech and preceptor programs, in order to ensure a holistic approach. UMC will develop or collaborate with an existing Simulation Lab that will provide an environment where graduate nurses can reinforce didactic content, learn and practice skills, and develop critical thinking, decision-making, and organizational skills, while providing holistic patient care.
In order to support these programs, UMC will recruit and hire nurse educators in their field of expertise. UMC will also develop unit-specific educational tracks for newly-hired graduate nurses. UMC will also conduct quality-improvement activities under these programs. UMC will assess the need for specialty services in its community, and use these nurse training programs as one means to begin meeting such identified needs.
Goals and Relationship to Regional Goals:
Project Goals: Under this project, UMC El Paso will focus on improving overall retention of nurses. UMC will also focus on realizing improvements in confidence, competency, organization and prioritization abilities, communication skills, leadership, and reduction in stress levels for nurses. All these improvements will result in highly-specialized and better patient care for UMC’s entire patient population, especially the high number of underserved and unfunded patients which UMC regularly treats.
This project meets the following regional goals: This project meets the regional goal of increasing the number of specialists and scope of services offered in the community. This project will increase specialty services by expanding residency programs for specialty areas of identified need, thus bringing more specialty providers to the region.
Challenges:
A major challenge facing the implementation of this project is the high turnover rate for graduate nurses at UMC El Paso.
5-Year Expected Outcome for Provider and Patients:
UMC expects that the establishment of these nurse training programs will raise the retention rate for graduate nurses within the first two years of hire by 3%. UMC also expects that this project will improve TCS nursing services within these programs.
Starting Point/Baseline:
In 2010, the turnover rate for graduate nurses employed at UMC El Paso was 44%; a total of 16 graduate nurses were hired and 7 have left the organization. In 2011, the turnover rate for graduate nurses employed at UMC El Paso was 44%; a total of 36 graduate nurses were hired and 16 have left the organization. In 2012, the turnover rate for graduate nurses employed at UMC El Paso since January is 18%; a total of 16 graduate nurses were hired and 3 have left the organization to date.
Rationale:
The Institute of Medicine (IOM) has developed eight recommendations on improving the future of healthcare. The IOM states, “Nurses are going to have a critical role in the future, especially in producing safe, quality care and coverage for all patients in our health care system.” IOM recommendation 3 is a recommendation that hospitals and educators implement nurse residency programs. The IOM believes that State Boards of Nursing, accrediting bodies, the federal government, and health care organizations all ought to support nurses in transitioning into new clinical practice areas.
UMC El Paso’s nurse residency and nurse tech programs will be established to assist new graduate nurses and nursing students seeking on-the-job training to transition into the profession of nursing in the hospital acute care setting. Through formal, clinical, and simulation training built on an evidence-based curriculum, the nurse residency and nurse tech programs will focus on strengthening proficiency and, even more importantly, ensuring the effectiveness of each nurse’s role in patient safety and patient outcomes.
Project Components: 1.9.1 Expand high impact specialty capacity in most impacted medical specialties
The expansion of specialty residency programs at UMC El Paso will accomplish the following core project components (a-d):
a) Identify high impact/most impacted specialty services and gaps in care and coordination.
o UMC will continue to assess the need for specialty services in the El Paso community which may be provided by nurses.
b) Increase the number of residents/trainees choosing targeted shortage specialties
o UMC will increase the number of providers in the targeted specialties by establishing nurse residency and nurse tech programs to train nurses for these specialties.
c) Design workforce enhancement initiatives to support access to specialty providers in underserved markets and areas (recruitment and retention)
o UMC intends that these expanded nurse residency training programs will provide residents and trainees with positive exposure to opportunities in El Paso, increasing the likelihood that these nurses can be successfully recruited to (and/or retained in) the El Paso community.
d) Conduct quality improvement for project using methods such as rapid cycle improvement. Activities may include, but are not limited to, identifying project impacts, identifying “lessons learned,” opportunities to scale all or part of the project to a broader patient population, and identifying key challenges associated with expansion of the project, including special considerations for safety-net populations.
o UMC will conduct quality improvement activities as part of the programs established under this project.
Unique community need identification numbers the project addresses:
· CN-2: Secondary and Specialty Care
How the project represents a new initiative or significantly enhances an existing delivery system reform initiative:
This project will significantly enhance UMC’s efforts to train nurses and recruit and/or retain them in the El Paso community. Because these new nurse residency and training programs will increase the likelihood that new graduates will choose to practice their specialties in El Paso, and that graduate nurses will remain in El Paso, this project will significantly enhance UMC’s ability to train, recruit, and retain new mid-level specialty providers to serve patients in the region.
Related Category 3 Outcome Measures:
OD-11 Health Disparities in Minority Populations
IT-11.6 Other Outcome Improvement Target - TBD
Reasons/rationale for selecting the outcome measures:
Waiting on HHSC / CMS direction for residency projects. TBD
Relationship to other Projects: UMC has several other projects dedicated to expanding access to primary or specialty care, including Establishing the Crossroads Clinic in South-western El Paso (138951211.1.3); Enhancing Quality Improvement in the UMC NHCs (138951211.1.7); Expanding Primary Care at Ysleta and Fabens (138951211.1.5); and Expansion and Enhancement of Medical Homes at UMC NHCs (138951211.2.4).
Relationship to Other Performing Providers’ Projects and Plan for Learning Collaborative: Providence and Sierra East are also developing projects to support the expansion of access to primary or specialty care in the community. TTUHSC is developing a residency project that will complement UMC’s nurse residency project.
Performing Providers, IGT entities, and the Anchor for Region 15 have held consistent monthly meetings throughout the development of the Waiver. As noted by HHSC and CMS, meeting and discussing Waiver successes and challenges facilitates open communication and collaboration among the Region 15 participants. Meetings, calls, and webinars represent a way to share ideas, experiences, and work together to solve regional healthcare delivery issues and continue to work to address Region 15’s community needs. UMC, as the Region 15 Anchor anticipates continuing to facilitate a monthly meeting, and potentially breaking into workgroup Learning Collaboratives that meet more frequently to address specific DSRIP project areas that are common to Region 15, as determined to be necessary by the Performing Providers and IGT entities. UMC will continue to maintain the Region 15 website, which has updated information from HHSC, regional projects listed by Performing Provider, contact information for each participant, and minutes, notes and slides from each meeting for those parties that were unable to attend in-person.
Region 15 participants look forward to the opportunity to gather annually with Performing Providers and IGT entities state-wide to share experiences and challenges in implementing DSRIP projects, but also recognize the importance of continuing ongoing regional interactions to effectuate change locally. Through the use of both state-wide and regional Learning Collaborative components, Region 15 is confident that it will be successful in improving the local healthcare delivery system for the low-income and indigent population.
Project Valuation
The valuation of each UMC project takes into account the degree to which the project accomplishes the triple aim of the Waiver, the degree to which the project addresses community needs, the acuity and number of patients served by the project, and the investment required to implement the project. This project also takes into account the costs and health complications that can be avoided when a patient population receives the right care in the right setting, rather than being forced to utilize the Emergency Department as its primary healthcare resource. This project will significantly address the needs of the El Paso community by increasing the capacity to provide specialty care services and the availability of targeted specialty mid-level providers to better accommodate the high demand for specialty care services so that patients have increased access to specialty services.
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138951211.1.6 / 1.9.1 / 138951211.1.9.1 / Expanded Residency Program /University Medical Center of El Paso / 138951211 /
Related Category 3 Outcome Measure(s): / IT-11.6 / 138951211.3.6 / Other Outcome Improvement Target /
Year 2
(10/1/2012 – 9/30/2013) / Year 3
(10/1/2013 – 9/30/2014) / Year 4
(10/1/2014 – 9/30/2015) / Year 5
(10/1/2015 – 9/30/2016) /
Milestone 1 [P-1]: Conduct specialty care gap assessment based on community need.
Metric [P-1.1]: Documentation of gap assessment.
Baseline/Goal: Completion of gap assessment.
Data Source: Needs assessment.
Milestone 1 Estimated Incentive Payment: $1,272,849
Milestone 2 [CQI P-19]: Participate in at least bi-weekly interactions (meetings, conference calls, or webinars) with other providers and the RHP to promote collaborative learning around shared or similar projects.
Metric [P-19.1]: Number of bi-weekly meetings, conference calls, or webinars organized by the RHP that the provider participated in.
Data Source: Documentation of weekly or bi-weekly phone meetings, conference calls, or webinars including agendas for phone calls, slides from webinars, and/or meeting notes
Milestone 2 Estimated Incentive Payment: $1,272,849 / Milestone 3 [P-2]: Train care providers and staff on processes, guidelines, and technology for referrals and consultations into selected medical specialties.
Metric [P-2.1]: Training of staff and providers on referral guidelines, process, and technology.
Numerator: Number of staff and providers trained and documentation of training materials
Denominator: Total number of staff and providers working in specialty care.
Baseline: New program, will measure number of graduate nurses completing program in each year
Data Source: Log of specialty care personnel trained and curriculum for training.
Milestone 3 Estimated Incentive Payment: $1,388,610
Milestone 4 [CQI P-19]: Participate in at least bi-weekly interactions (meetings, conference calls, or webinars) with other providers and the RHP to promote collaborative learning around shared or similar projects.
Metric 1 [P-19.1]: Number of bi-weekly meetings, conference calls, or webinars organized by the RHP that the provider participated in.
Data Source: Documentation of weekly or bi-weekly phone meetings, conference calls, or webinars including agendas for phone calls, slides from webinars, and/or meeting notes
Milestone 4 Estimated Incentive Payment: $1,388,610 / Milestone 5 [I-31]: Increase TSC training and/or rotations.
Metric 1 [I-31.2]: Increase the number of TSC trainees rotating at the Performing Provider’s facilities.
Baseline/Goal: Increase number of TSC nurse residents/trainees rotating at UMC by 25% over DY2 baseline.
Data Source: Student/trainee rotation schedule.
Milestone 5 Estimated Incentive Payment: $2,785,293 / Milestone 6 [I-31]: Increase TSC training and/or rotations.
Metric 1 [I-31.2]: Increase the number of TSC trainees rotating at the Performing Provider’s facilities.
Baseline/Goal: Increase number of TSC nurse residents/trainees rotating at UMC by 50% over DY2 baseline.
Data Source: Student/trainee rotation schedule.
Milestone 6 Estimated Incentive Payment: $2,300,894
Year 2 Estimated Milestone Bundle Amount: $2,545,698 / Year 3 Estimated Milestone Bundle Amount: $2,777,220 / Year 4 Estimated Milestone Bundle Amount: $2,785,293 / Year 5 Estimated Milestone Bundle Amount: $2,300,894
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD: $10,409,105
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