Date of Graduation

Spring 5-21-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Mary Donnelly

Abstract

ED overcrowding has been an issue for Facility X pre-COVID19 and has been exacerbated following the first shelter in place mandate around March 2020. Facility X had proposed to increase the amount of interfacility transfers (IFT) to mitigate overcrowding and, hopefully, improve patient outcomes. 2020 Census data had shown that patient satisfaction scores and Nurse Daily Engagement scores were down; leading Facility X to believe that there can be improvements made to the IFT workflow and communication. Patient interviews also revealed that not all patients were satisfied with how they were treated during the IFT process. This quality improvement project focused on improving the IFT workflow through the implementation of a rapid workshop. Stakeholders all throughout the ED attended this workshop to collaborate and resolve underlying issues within the IFT processes. A revised IFT workflow and AIDET communication framework (Acknowledge, Introduce, Duration, Explanation, Thank You) was developed by the end of the workshop. Three education sessions were then hosted to disseminate what had transpired during the rapid workshop and the AIDET framework tool was delivered to remaining ED staff. The tools utilized to measure the success or failure of the quality improvement was through staff surveys and the daily number of IFTs. Pre-intervention, 41% of the 17 staff members surveyed felt they were slightly or not comfortable with communicating IFTs with patients and about 77% of them were sometimes, rarely, or never using AIDET during their patient interactions. After implementation of the new IFT workflow and AIDET script, 100% of the 21 staff members surveyed were comfortable or extremely comfortable discussing IFTs with patients and 61% of staff sometimes or usually used AIDET during their interactions. Post-intervention, daily IFT goals were consistently achieved from an average of about three patients transferred per day to five or more transfers. IFTs will continue to be an important metric to maintain, while ED admissions continue to increase, due to location, representation, and COVID19 trends. With this in mind, IFT improvements will need to be upheld in order to keep the key metrics trending positively and ED overcrowding to a minimum.

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