Date of Graduation

Summer 8-9-2023

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

David Ainsworth

Second Advisor

Liesel Buchner

Abstract

Abstract

Background: The setting for this quality improvement project is a 22-bed medical telemetry unit that receives approximately 85% of ED admissions. The capacity challenges are one of the major causes of ED admissions beyond the 60-minute benchmark. To create capacity, discharges should happen earlier on the day or before 1:00 p.m. to be able to admit patients within 60 minutes from when the physician writes an order to patient transfer to the telemetry unit.

Problem: Patients are being boarded in the ED for extended times while waiting for an inpatient bed assignment. Longer boarding time in the ED is associated with higher morbidity and mortality rates. In the project setting, patients are routinely boarded in the ED longer than 60 minutes from when an order to admit is written to when the patient reaches the assigned bed. According to McKenna et al. (2019. By looking at ED-to-bed numbers and statistics for East Bay for March, 97% of ED patients were transferred from the ED greater than 60 minutes, with only 3% making it within 60 minutes. Metrics that matter for this unit include a target for patients who have the order to transfer from the ED to the unit. That target is 60 minutes across the entire northern California region. There needs to be balanced demand and capacity in this microsystem.

Interventions: This project aimed to introduce and test a daily noon demand capacity huddle to expedite safe discharge and create more capacity for ED patients that need inpatient beds. The goal was to decrease patient wait time for an inpatient bed, thus improving ED to an inpatient bed within 60 minutes or less from the time of admit order entry. The transfer of patients within 60 minutes or less will help in the timely execution of interventions contributing to decreased LOS, complications, and waste in the system leading to overall patient and healthcare team satisfaction.

Outcome Measures: The outcome measure of this project is to improve patient movement from the ED to an inpatient bed to at least 50% of patients within 60 minutes from when the physician writes the admission order to when the patient leaves the ED by July 2023. The process measure of this project includes the percentage of patients who are discharged before 1:00 p.m. and the percentage of patients assigned a bed within 15 minutes of an order entry. The balancing measure of this project is that an increase in expediency with room turnover can compromise patient safety by not following the infection control process.

Results: ED to Bed decreased from April 2023 (six hundred and sixteen minutes) to Four hundred and thirty-four in June 2023. The discharge percentage before 1 pm in April 2023 was 37% and slightly improved in June 2023, at 38%. ED to bed overall percentage was 5% in June 2023 compared to the 3% rate in April 2023

Conclusion: Implementing the daily noon huddle designed to address inpatient capacity constraints and improve patient care outcomes did slightly improve ED to bed time within three months of implementation.

Keywords: ED to bed, demand capacity, overcrowding

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