Date of Graduation

Fall 12-15-2017

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Elena Capella, EdD, MSN, MPA, RN, CNL, CPHQ, LNCC


Primary care follow-up after an emergency department (ED) visit is an important component of comprehensive healthcare, contributing to both improved patient outcomes and reduced readmissions to emergency care. In alignment with the Clinical Nurse Leader (CNL) roles of risk anticipator and lateral integrator of care, this project aimed to support improvement in care continuity for patients at a large primary care clinic in London. At this clinic, a team of physicians, nurses, and support staff care for a diverse population of adult and pediatric patients who account for nearly 3,000 ED visits annually. Assessment of the clinical review process used to coordinate post-emergency follow-up revealed that less than 22% of patients receive timely care and the process to initiate care takes an average 15 days to complete. To address this gap in quality and efficiency, an interprofessional team utilized root-cause analyses, process optimization, and small tests of change to develop an optimized clinical review process for post- emergency department follow-up care. Implementation of the process resulted in an 81.3% decrease in clinical review time and a 34.5% increase in on-time follow-up care. Process optimization is an effective framework through which rapid improvements in care processes can be implemented to enhance care quality and efficiency.