The Traumatic Brain Injury unit at TIH treats patients with mild to severe injuries. Most arrive from the Emergency Department, but we also treat patients who may have suffered a brain injury previously. Patients in the unit experience symptoms ranging from headache, fatigue, memory loss, dizziness or loss of balance, irritability, or other emotional disturbance to cognitive deficits, speech and language issues, sensory and perceptual difficulties, physical changes, and social and emotional changes. We staff a psychologist, occupational, rehabilitation and recreation therapists, speech and language pathologists, neuropsychologists, social workers and counselors, and specialist nurses all with a working knowledge and experience in treating those with traumatic brain injuries. The unit has faced several difficulties recently, including a slow adoption to technology, staff shortage, and a moderate to high turnover rate due to poor job satisfaction. If this continues, our patients and their families may seek treatment at another facility due to the potential of dissatisfaction. Firstly, in order to properly treat patients, we must provide the highest level of care which we cannot do if the technology available to us is not utilized. Secondly, the variety of specialists in this unit were selected based upon patient need and volume. Inadequate staffing puts patients at risk for preventable harm (Simpson). Staff shortages have led to high turnover rates because employees are worked harder, oftentimes longer, and they burnout. They leave this department to go to another which they intend to enjoy more, work less, be able to provide more to their patients, and where they believe they can thrive doing what they are hired to do. Due to the nature of their presence in this department, our patients need consistency in staff employment in order to build and maintain relationships and trust with the personnel providing them with the most sensitive of care. Studies show that managing turnover rates are critical to delivering high-quality patient care (Bae). To resolve the issue of the Traumatic Brain Injury (TBI) Unit’s slow adoption to technology we must first address the reason. Although our brain scanning through use of CT and MRI is on par with other facilities around the country and we have highly trained technicians, where we are falling short is in the implementation of health information technology. The primary aim in adoption of HIT was to improve the quality of care and reduce medication errors. The adverse factors in implementation we are seeing is similar to those revealed in an investigation of a South Carolina hospital: barcode scanning tasks, computer interface or operating issues, unfamiliar procedures, and logistic issues (Yuan-Han). Resolving these issues requires a high degree of clinical interaction between the IT department and medical staff as well as with patients and the technology itself, with interdepartmental coordination, for example, between the pharmacy and nurses regarding documentation of uncategorized drugs. Communication with the IT department and the HIT vendor will help to resolve technical issues that may arise in order to continually alter coding that may be disruptive to workflow. Proper and continuous computer and IT training is necessary to alleviate operation problems, as well as the availability of easy-to-read operation manuals for troubleshooting, as Yuan-Han’s research concluded. We believe that solving staff shortage and poor job satisfaction rates are intertwined. We are short staffed because employees are transferring to different units or facilities and the reason they are leaving is because they are dissatisfied. Similarly, other employees are dissatisfied because others are leaving increasing their workload. We tried to discover which came first, the dissatisfaction or the shortage, but eventually we reached the conclusion it did not matter because our patients would suffer if either or both continued. In this unit, staff is faced with a multitude of challenges due to the range of patient ailments. We believe the key in resolution is connection. While some of our patients can be difficult at times to communicate effectively with, we need employees who are willing to continue to try. The hiring process should focus on potential employees’ interest and passion specifically for the type of patients in this unit. At times, we will need to look outside of the hospital itself, take advantage of nearby universities’ new graduates and give them the opportunity to bring their passion here. Also, the organizational structure in place now on the unit is not fluid. The same patient could be treated by every nurse on the unit within a short stay, their family may not know names of physical therapists, social workers, or physicians. We need to assign specific staff members to each patient, essentially creating a team atmosphere so that information is relayed effectively, patients and families are familiar with those treating them, and relationships are encouraged. We recognize that resolving these three issues of staff shortage, poor job satisfaction with moderate to high turnover, and the department’s slow adoption to technology will take some time. We will immediately reach out to local schools and provide the opportunity to their students to integrate in the department and complete clinical hours here with the likelihood of job placement upon graduation, but this could like upwards of four months to reach completion. We will immediately redesign the organizational structure and assign teams to each patient in order to promote relationships and market job postings within and outside of the hospital and hopefully improve job satisfaction as quickly as possible. Coordination between the IT department and HIT vendors begins immediately to address operational issues between staff and the computer system. We expect to see positive results within six months to one year with steady improvement overall.
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