Date of Graduation

Fall 12-5-2022

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Dr. Sara Horton-Deutsch

Second Advisor

Dr. Catherine Coleman

Abstract

PROBLEM: According to the Institute of Medicine, boarding inpatients in the emergency department (ED) can result in an increased risk for medical errors, delay in treatments, and decreased quality of care. The goal is to move the patient to the hospital bed within 60 minutes from when an order is written for admission. The current average monthly compliance for ED throughput and admission to the inpatient bed is at 45% compared to the target of 70%. Lack of standardization during handoff can lead to delays, miscommunication and causes team frustration.

CONTEXT: In 2022, this community hospital’s ED microsystem had limited capacity, and increased ED volume compared to 2021. The hospital measures ED admissions to inpatient bed as a performance metric. One microsystem and one shift on a telemetry (tele) unit were identified to test and analyze new approaches to reduce delays, optimize nurse communication, decrease team frustration, and create a realistic business case. A 15% improvement was projected to yield an increase in efficiency by $60,346.44 for the tele unit. The ED’s loss for six months was estimated at $1,011,832.70 so a 15% improvement could yield a benefit of $151,774.90.

INTERVENTIONS: In-person hand-off between the ED and the telemetry nurse was implemented. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) evidence-based tool SBAR (Situation, Background, Assessment, Recommendation) was adopted to standardize reporting. The change was initially implemented on one shift, utilizing small test cycles, and was later established as a standard of communication on all shifts.

MEASURES: The primary outcome measure was to track the ED to bed metric before and after each test of change with a target of 15% improvement over six months. The process measure included measuring nurse satisfaction with the current handoff process and the rate of compliance with the use of the SBAR tool on one shift (evenings). By July 1st, 2022, 65% of admissions on the second shift on the Telemetry unit were to experience a 1:1 handoff between the ED and the Telemetry nurse within 60 minutes from the time admit order is written utilizing the standardized TeamSTEPPS SBAR tool.

RESULTS: Over six months, the practice change resulted in partial improvement. The time it took for the patient to leave the ED, from when the bed was assigned, decreased from 76 minutes to 26 minutes from January to April 2022. Interim data indicates the overall outcome measure remained unchanged at 45%. Standardization led to the timely start of care interventions on the telemetry unit leading to increased care team satisfaction.

CONCLUSION: A Clinical Nurse Leader can effectively lead and collaborate between different microsystems to test and implement evidence-based tools and strategies to improve clinical, staff, and operational outcomes.

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