We all know the effects of the pandemic. The PACT (patient-aligned care team) model for patient care became “diseased.” Accessing care became limited due to CDC (Centers for Disease Control) workplace guidance and recommendations. Staffing was severely affected by shortages as PACT nurses left, exercised early retirement, or were reassigned to support the inpatient hospital resulting in PACT’s scrambling for coverage. This went on for 2 years.
The outpatient CNL (clinical nurse leader) recognized the departure from the PACT model to address the needs of the patient caused by the pandemic defaulted to the team nursing model being utilized. Our CNL proactively conducted a “pulse check” with the results of this cohort survey showing the biggest challenges to using the PACT model included shortfalls to the scheduling, staffing, PACT panel size, unclear roles of staff, workload expectations perceived as unrealistic, lack of teamwork, and ineffective communication.
Primary care and nursing administration responded to the results of the survey and conceptualized the development of a PACT hub of excellence aimed to improve the knowledge of staff on resuming the use of the PACT model. PHE started as a 120-day detail to create a process improvement and sustainment program for excellence in primary care. The goal is to provide one primary care subject matter expert at each of the major primary care clinics to act as the coach/educator for PACT. A curriculum for training was developed and named the PACT reboot to re-educate and reinvigorate PACT team members to use the PACT model for patient care. Training began in February and extended into August 2022; 22 classes were held, and 56 PACTs were trained, with a total of 314 PACT members attending the training in total.
Longitudinal cohort surveys conducted showed 86% of the responding attendees were satisfied with the knowledge gained and felt they achieved the desired learning outcomes for the training. HEDIS (Healthcare Effectiveness Data and Information Set) performance measures for diabetes and Ischemic heart disease associated with the attending PACTs were reviewed by facility and comparing the PACT clinical performance scores pre- and post-training. The results reviewed reflected an improvement in the management related to chronic care.
Reflecting this success, the PHE program was made permanent, and staffing was enhanced. Currently, a provider and additional nursing coach have been added to the program. PHE coaching of the PACTs in each clinic remains ongoing. A new employee “bootcamp” 5-day training has been developed to train new PACT employees on PACT processes. Information on the PHE presentations, training techniques, and the success of the program are shared with other PACT educators within the system network.

Barbara-Ann Kelly MSN, Ed, RN

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