Date of Graduation

Winter 12-15-2017

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




DNP Completion

First Advisor

Brian M. Budds, MS, JD

Second Advisor

Nancy W. Selix, DNP



Challenges have been presented to the Emergency Department (ED) over the last several years as the dramatic rise in health insurance enrollment continues. Although, with the Republican bill, the American Health Care Act, changes to Medicaid may alter the health program leaving many uncertainties (Kaplan & Pear, 2017). Evidence reflects EDs are inundated with even more patients taking advantage of the availability of a one-stop shop for their care and treatment. Costs of ED services and resource allocation are rising as a result of these unnecessary visits contributing to a total healthcare expenditure of approximately 17.6% of the US Gross Domestic Product (GDP) (Horst, Martin, Gambler, & Coco, 2011). Various quality improvement measures have been implemented across the nation to reduce these costs such as the utilization of PreManage EDTM. The PreManage EDTM implementation pilot in Alameda County enables identification of patients frequently using ED services within a shared geographical region (Azar, Pressman, Oehmke, & Xu, 2017). This quality improvement project sought to educate the nursing staff, increasing their knowledge and awareness of PreManage EDTM, health care resources, and assisting the health care team to provide improved access for patients’ non-urgent healthcare needs. Prior to the education, a pre and post survey obtained a direct correlation between assessment and knowledge as a result of the education which was reflected utilizing the Wilcoxon Signed-Ranks Test with a Z=278, p < .0001, indicating that the intervention nurses scored higher on the posttest increasing their knowledge basis. Additional research is needed to understand the underlying causes that contribute to ED utilization and improved outcomes to facilitate data-sharing within regions across different health systems.

Keywords: emergency care, frequent flier, non-urgent high utilizers, one-stop shop