Bridging the Gap - Building Better Care - Expanding Emergency Department Paramedic Practice

2.50
Hdl Handle:
http://hdl.handle.net/10755/198348
Title:
Bridging the Gap - Building Better Care - Expanding Emergency Department Paramedic Practice
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Bridging the Gap – Building Better Care – Expanding Emergency Department Paramedic Practice

Purpose: Emergency Departments with increasing patient volumes, limited space, and continued shortage of experienced ED nurses, require a different approach to patient care to deter flow issues. Practice innovations, using an expanded paramedic practice model, increases the level of care assistance to the ED bedside nurse, and ultimately benefits patients, staff and overall department efficiency.

Design: In most ED’s Paramedics function as lower-level technicians performing activities such as phlebotomy/IV, patient transport, EKG’s. The first step in expanding the scope of Paramedic practice in this ED was to revise the current role, education requirements and expectations. This included job description revision and rewriting competencies. The second step focused on building and enriching the nurse-paramedic relationship within the ED setting. In the final step, a six-month pilot program of the newly expanded role was implemented, enabling paramedics, under the supervision of the ED Registered Nurse, to provide a broader scope of patient care activities.

Setting: The setting is a 35-bed urban, academic, adult Emergency Department, with 57,000 annual visits. This tertiary facility, with five satellite hospitals, is a primary referral center for AMI, Stroke, Transplant, Orthopedics and Oncology for multiple care centers in the mid-south tri-state area.

Participants/Subjects: Thirteen current and five newly hired licensed paramedics, with at least three years EMS experience, were selected for the initial program re-design. Age range of participants was comparable at 25 – 45 years, and gender was almost equal with 10 male and 8 female participants. No IRB requirements applied since this was an internal department practice change.

Methods: Collaboration between Nursing, Paramedics, Physicians and Pharmacy resulted in a review of the TN EMS Licensure parameters, current paramedic job role revision needs, and establishing staff and physician expectations. Support from Hospital Administration was crucial to the implementation of a newly expanded orientation process and program pilot. All Paramedics attended an 8-hour procedural cadaver lab for skill competency validation, and a 15-module Pharmacology review course with a knowledge validation post-test. ED nurses created documentation classes. Each Paramedic was then partnered with ED RNs for two 12-hour shadow days; focusing on medication administration, documentation and collaboration in patient care. Data, pre-and-post implementation, was collected and analyzed for LWBS, AMA, and door to MSE. Hospital administered patient satisfaction scores were trended and analyzed. Likert-type satisfaction surveys were created, validated and distributed to staff and physicians.

Results/Outcomes: Noted improvement in patient, staff and physician satisfaction. The rates for LOS, LWBS and AMA have decreased. The time from patient arrival to MSE has also decreased, resulting in more efficient patient flow.

Implications: This systematic approach to expanding the paramedic scope of practice in the ED is vital and necessary in today’s emergency medicine climate. ED’s all over the country are faced with overcrowding, increased acuity, decreased associate satisfaction and staff “burn-out” In addition to a better patient-focused efficient care delivery model, the ED unexpectedly has earned a reputation in the EMS community as an employer and provider of choice.

Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleBridging the Gap - Building Better Care - Expanding Emergency Department Paramedic Practiceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198348-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Bridging the Gap – Building Better Care – Expanding Emergency Department Paramedic Practice<br/><br/>Purpose: Emergency Departments with increasing patient volumes, limited space, and continued shortage of experienced ED nurses, require a different approach to patient care to deter flow issues. Practice innovations, using an expanded paramedic practice model, increases the level of care assistance to the ED bedside nurse, and ultimately benefits patients, staff and overall department efficiency.<br/><br/>Design: In most ED’s Paramedics function as lower-level technicians performing activities such as phlebotomy/IV, patient transport, EKG’s. The first step in expanding the scope of Paramedic practice in this ED was to revise the current role, education requirements and expectations. This included job description revision and rewriting competencies. The second step focused on building and enriching the nurse-paramedic relationship within the ED setting. In the final step, a six-month pilot program of the newly expanded role was implemented, enabling paramedics, under the supervision of the ED Registered Nurse, to provide a broader scope of patient care activities.<br/><br/>Setting: The setting is a 35-bed urban, academic, adult Emergency Department, with 57,000 annual visits. This tertiary facility, with five satellite hospitals, is a primary referral center for AMI, Stroke, Transplant, Orthopedics and Oncology for multiple care centers in the mid-south tri-state area.<br/><br/>Participants/Subjects: Thirteen current and five newly hired licensed paramedics, with at least three years EMS experience, were selected for the initial program re-design. Age range of participants was comparable at 25 – 45 years, and gender was almost equal with 10 male and 8 female participants. No IRB requirements applied since this was an internal department practice change.<br/><br/>Methods: Collaboration between Nursing, Paramedics, Physicians and Pharmacy resulted in a review of the TN EMS Licensure parameters, current paramedic job role revision needs, and establishing staff and physician expectations. Support from Hospital Administration was crucial to the implementation of a newly expanded orientation process and program pilot. All Paramedics attended an 8-hour procedural cadaver lab for skill competency validation, and a 15-module Pharmacology review course with a knowledge validation post-test. ED nurses created documentation classes. Each Paramedic was then partnered with ED RNs for two 12-hour shadow days; focusing on medication administration, documentation and collaboration in patient care. Data, pre-and-post implementation, was collected and analyzed for LWBS, AMA, and door to MSE. Hospital administered patient satisfaction scores were trended and analyzed. Likert-type satisfaction surveys were created, validated and distributed to staff and physicians. <br/><br/>Results/Outcomes: Noted improvement in patient, staff and physician satisfaction. The rates for LOS, LWBS and AMA have decreased. The time from patient arrival to MSE has also decreased, resulting in more efficient patient flow.<br/><br/>Implications: This systematic approach to expanding the paramedic scope of practice in the ED is vital and necessary in today’s emergency medicine climate. ED’s all over the country are faced with overcrowding, increased acuity, decreased associate satisfaction and staff “burn-out” In addition to a better patient-focused efficient care delivery model, the ED unexpectedly has earned a reputation in the EMS community as an employer and provider of choice.<br/><br/>en_GB
dc.date.available2011-12-21T12:46:48Z-
dc.date.issued2011-12-21T12:46:48Z-
dc.date.accessioned2011-12-21T12:46:48Z-
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