from 60 percent to 90 percent, and today
stands at 95 percent (see Table 1). Staff
satisfaction with the plans of care rose
significantly as well, especially as a result
of bringing evidence to the point of care.
Care has become far more standardized
while still allowing for patient-centered
differences where appropriate, and White
Plains Hospital continues to meet Magnet
designation requirements for evidence-based practice.
Since the adoption of the new interdisciplinary plans of care, Average Length
of Stay was reduced from 4.81 days to 4.75
days. Multiply that by the number of nurses
per shift per day across a full year and the
reduction is substantial. The number of
steps required to put a patient on a plan of
care has been decreased, reducing errors
while increasing compliance. In addition,
30-day readmissions have dropped, from
10. 8 to 10. 2 as a result of better continuity
The cultural transformation brought
about, in part, by the interdisciplinary
plans of care contributed to White Plains
Hospital attesting to Meaningful Use Stage
2 in 2014. The effects continue to be felt in a
positive way throughout the hospital.
CONTINUITY AROUND THE PATIENT
Most clinicians and healthcare organi-
zations would agree on the importance
of keeping patients at the center of their
own care – at least in theory. All too often
in practice, however, this mindset seems
to be set aside by the crushing weight of
tasks (including documentation) that have
grown around patient care. Coupled with
the reality of clinicians and other caregivers
working in siloes rather than in collabora-
tion, it’s no wonder that patient care, and at
times even patient safety, can suffer.
Helping patients safely move to the next
level of care as quickly as possible cannot
occur if care team members are left in the
dark regarding the activities of others.
Generic plans of care that serve as checklists of nursing tasks rather than focusing
on specific, evidence-based patient needs
further exacerbate this issue, creating
distractions rather than advancing the
The creation of evidence-based interdisciplinary plans of care helps overcome
these issues and ensure that all care team
members are working together toward a
common goal. The experience of White
Plains Hospital demonstrates the effectiveness of this approach and the results it can
deliver in terms of improving care quality,
lowering costs and enhancing patient (and
staff) satisfaction. JHIM
Romina Hipolito Elias, MSN, RN-BC, is director
of Nursing for maternal child health at White
Plains Hospital. Clarissa Tojos, RN-BC, is a senior
ambulatory analyst for White Plains Hospital.
1. Bodenheimer, T. Coordinating care—a
perilous journey through the health care
system. N Engl J Med. 2008;358( 10):1064-
1071. Accessed 11/23/15. http://www.nejm.
2. Hussey, P.S., PhD; Schneider, E.C., MD;
Rudin, R.S., PhD; Fox, S., MD; Lai, J.,
MPH; Pollack, C.E., MD. Continuity and the
costs of care for chronic disease. JAMA
Intern Med. 2014;174( 5):742-748. Accessed
3. Institute of Medicine. Priority Areas for
National Action: Transforming Health Care
Quality. Washington, DC: National Academies
4. Buell E.L. The Case Study as a Method
of Teaching Students and Graduates the
Principles of Public Health Nursing. The
American Journal of Nursing. 30( 4): 399-407.
Accessed 11/23/15. http://www.jstor.org/
5. Dellefield M.E. Interdisciplinary care planning
and the written care plan in nursing homes: a
critical review. Gerontologist 2006;46:128–33.
Accessed 11/23/15. http://gerontologist.
6. Mauksch, I. G., & Mauksch, J. O. Value of
the nursing care study. American Journal of
Nursing, 50(1); 44-46.
7. Wagner, B. The nursing care plan. Nursing
Outlook, 61( 9), 172-174.
8. Joint Commission on Accreditation of
Hospitals. (1969). Standards for accreditation
of hospitals. Chicago, IL.
9. Henderson, V. On nursing care plans and
their history. Nursing Outlook, 73( 6), 378-379.
10. Gray, J. W., & Aldred, H. Care plans in
long-term facilities. American Journal of
Nursing, 80, 2054-2057.
11. Hendrich, A., R.N., M.S.N., F.A.A.N., Chow,
M.P., D.N.Sc., R.N., F.A.A.N., Skierczynski, B.,
Ph.D., Lu, Z., Ph.D. A 36-hospital time and
motion study: how do medical-surgical nurses
spend their time? The Permanente Journal.
Summer 2008 v 12( 3), 25-34. Accessed
12. Joint Commission on Accreditation of
Healthcare Organizations. Joint Commission
Center for Transforming Healthcare
releases targeted solutions tool for handoff communications. Joint Commission
Perspectives. 12( 8). Accessed 12/1/15. http://
13. Centers for Medicare & Medicaid Services.
(2015) National Health Expenditures Fact
Sheet. Washington, D.C. Accessed 12/1/15.
Helping patients safely move to the
next level of care as quickly as
possible cannot occur if care team
members are left in the dark regarding
the activities of others.