2.50
Hdl Handle:
http://hdl.handle.net/10755/162564
Type:
Presentation
Title:
What's the Wait? Another Option for I&D in the ED
Abstract:
What's the Wait? Another Option for I&D in the ED
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Doyle, Stacy, RN, MBA, CPN
P.I. Institution Name:Children's Mercy Hospitals and Clinics
Title:Emergency Department Manager
Contact Address:2401 Gilham Road, Kansas City, MO, 64108, USA
Contact Telephone:816-983-6281
Co-Authors:Mary Hegenbarth, MD; Georgia Stephens, RN, BSN, CNA-BC
Leadership Conference - Evidence-Based Practice Abstract: WhatÆs the Wait? Another Option for I&D in the ED

Purpose: Many patients are seen each year in the emergency department (ED) for abscesses requiring incision and drainage (I&D) with increasing numbers due to changes in bacterial pathogenicity. In the pediatric population many require sedation for this procedure leading to a long length of stay, delays for other ED patients, and risk associated with emergency sedation not following standard NPO guidelines. By treating this population through a more planned, organized approach, ED visits can be spread through a less populated time of day, NPO guidelines can be adhered to and patientsÆ experiences can be improved while facilitating departmental flow.

Design: The project is a process modification designed to improve patient flow, safety and satisfaction.

Setting: This intervention took place in an academic, urban, level one pediatric trauma center.

Participants/Subjects: Participants are patients presenting to ED who are triaged to the wound clinic if they have abscesses requiring drainage or with the potential to require drainage in the next 24 to 72 hours with no signs of systemic toxicity, high fever, need for immediate drainage or needed admission. Patients with I&D performed in the ED are sent to wound clinic for follow up and dressing change.

Methods: Patients who present to the ED with abscesses requiring drainage either have I&D performed and are given a follow up appointment in the wound clinic or are given routine care (antibiotics and pain medication) and an appointment for I&D in 24 to 72 hours in the wound clinic. ClinicÆs held three days a week in the less busy morning hours with 4 follow-up and 4 I&D sedation patients scheduled daily. A nurse contacts families the night before to review NPO instructions, answer questions and confirm the appointment. Upon arrival, assessment is performed, IVs are placed using numbing cream and child life and sedation and I&D are performed by physicians. The patients are given a follow-up appointment for dressing changes as needed and receive teaching before discharge. In a less hurried appointment, as opposed to an ED visit, more time and care is taken to make I&D as pain-free as possible.

Results/Outcomes: The clinic has seen approximately 700 patients since inception and has decreased length of ED stay for abscess patients. It has had very positive response from patients and families. Most days all appointments are filled and the no-show rate is extremely low. The days and hours have been expanded recently from 2 days a week to 3 to accommodate increased demand. Additionally, other providers have asked to refer patients to the clinic for I&D creating the opportunity to expand services beyond those presenting to the ED.

Implications: I&D is a time and resource consuming procedure. Grouping this population and providing resources in a planned way at a time when ED resources are underutilized can improve the overall patient flow and experience. This same program has the potential to be adapted and modified to be implemented with other populations requiring complicated or prolonged care.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleWhat's the Wait? Another Option for I&D in the EDen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162564-
dc.description.abstract<table><tr><td colspan="2" class="item-title">What's the Wait? Another Option for I&amp;D in the ED</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Doyle, Stacy, RN, MBA, CPN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Children's Mercy Hospitals and Clinics</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Emergency Department Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2401 Gilham Road, Kansas City, MO, 64108, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">816-983-6281</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">sdoyle@cmh.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Mary Hegenbarth, MD; Georgia Stephens, RN, BSN, CNA-BC</td></tr><tr><td colspan="2" class="item-abstract">Leadership Conference - Evidence-Based Practice Abstract: What&AElig;s the Wait? Another Option for I&amp;D in the ED<br/><br/>Purpose: Many patients are seen each year in the emergency department (ED) for abscesses requiring incision and drainage (I&amp;D) with increasing numbers due to changes in bacterial pathogenicity. In the pediatric population many require sedation for this procedure leading to a long length of stay, delays for other ED patients, and risk associated with emergency sedation not following standard NPO guidelines. By treating this population through a more planned, organized approach, ED visits can be spread through a less populated time of day, NPO guidelines can be adhered to and patients&AElig; experiences can be improved while facilitating departmental flow.<br/><br/>Design: The project is a process modification designed to improve patient flow, safety and satisfaction. <br/><br/>Setting: This intervention took place in an academic, urban, level one pediatric trauma center.<br/><br/>Participants/Subjects: Participants are patients presenting to ED who are triaged to the wound clinic if they have abscesses requiring drainage or with the potential to require drainage in the next 24 to 72 hours with no signs of systemic toxicity, high fever, need for immediate drainage or needed admission. Patients with I&amp;D performed in the ED are sent to wound clinic for follow up and dressing change. <br/><br/>Methods: Patients who present to the ED with abscesses requiring drainage either have I&amp;D performed and are given a follow up appointment in the wound clinic or are given routine care (antibiotics and pain medication) and an appointment for I&amp;D in 24 to 72 hours in the wound clinic. Clinic&AElig;s held three days a week in the less busy morning hours with 4 follow-up and 4 I&amp;D sedation patients scheduled daily. A nurse contacts families the night before to review NPO instructions, answer questions and confirm the appointment. Upon arrival, assessment is performed, IVs are placed using numbing cream and child life and sedation and I&amp;D are performed by physicians. The patients are given a follow-up appointment for dressing changes as needed and receive teaching before discharge. In a less hurried appointment, as opposed to an ED visit, more time and care is taken to make I&amp;D as pain-free as possible.<br/><br/>Results/Outcomes: The clinic has seen approximately 700 patients since inception and has decreased length of ED stay for abscess patients. It has had very positive response from patients and families. Most days all appointments are filled and the no-show rate is extremely low. The days and hours have been expanded recently from 2 days a week to 3 to accommodate increased demand. Additionally, other providers have asked to refer patients to the clinic for I&amp;D creating the opportunity to expand services beyond those presenting to the ED. <br/><br/>Implications: I&amp;D is a time and resource consuming procedure. Grouping this population and providing resources in a planned way at a time when ED resources are underutilized can improve the overall patient flow and experience. This same program has the potential to be adapted and modified to be implemented with other populations requiring complicated or prolonged care. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:30:19Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:19Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.