2.50
Hdl Handle:
http://hdl.handle.net/10755/198353
Title:
The Other Emergency Department: Subletting Space Equals Outcome
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] The Other Emergency Department: Subletting Space Equals Outcome

Purpose: Capacity issues continue to be a challenge in the ED. With the addition of mental health reform, psychiatric holding in the ED escalated adding to increased wait times and causing patient satisfaction and safety concerns. Emergency nurse driven teams used innovative practices of subletting spaces external to the ED to not only decompress the ED but increase ED throughput, outcomes and patient satisfaction.

Design: Evidence based project accomplished as a QI initiative. The two teams began with a barrier analysis and developed improvement actions addressing each. The hospital PRIDE model for improvement was applied using rapid cycle improvement techniques which utilize successive small experiments of change, PDSAs. Jean Watson’s Theory which guides the Professional Practice Model guided the team in the caritas approach to decompressing the ED leading and increasing patient satisfaction and patient outcomes.

Setting: 527-bed Acute Care Magnet Designated Hospital with a 33-bed Level 2 Emergency Department

Participants: ED direct care nurses and management, Center for Psychiatry (CFP) staff and management, ED physicians, Psychiatrists, Administration, QI Facilitators and key collaborative members from all departments across the organization.

Methods: Two multidisciplinary teams were developed. The first team focused on ways to decrease psychiatric holding in the ED. The second team focused on processes for sharing space external to the ED to deliver care to an increasing ED patient population. The teams met biweekly or more often as needed to review data pertinent to their objectives and conducted many small experiments of change. A few examples include communication and hand off reports for use between the ED and CFP, triage and transportation between the areas, staffing allocation, resources and equipment, and medication administration. The data was used to drive process change and improvement. Many experiments required pilot studies that often led to lasting change.

Results/Outcome: An average of approximately 60 patients per month utilize the Transitional Care Area (TCA) decompressing and saving the ED an average of 560 hours. The Extended Care Area (ECA) which operated only hours per week in its pilot stage now operates 60 hours per week serving approximately 35 patients per day. The development of these teams helped drive additional positive outcomes. The rate of patients leaving without being seen reduced to 1.4% in December with an average volume of 167 patients per day. Patient satisfaction for the same period was at the 82nd percentile.

Implications: Process change and nurse driven innovation can help make the difference between ED flow and virtual standstill. ED direct care nurses working interdepartmentally to lead improvement initiatives leads to better ED patient satisfaction and outcomes and ultimately to the decompression of the ED and increased ED throughput.

The Four Key Drivers to Success are: 1. Communication: Open, honest, collegial relationships
2. Collaboration: Team-centered approach to experiments of change 3. Commitment: Accept setbacks, stay positive, and recognize opportunities 4. Care: Patient centered care


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

Full metadata record

DC FieldValue Language
dc.titleThe Other Emergency Department: Subletting Space Equals Outcomeen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198353-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] The Other Emergency Department: Subletting Space Equals Outcome<br/><br/>Purpose: Capacity issues continue to be a challenge in the ED. With the addition of mental health reform, psychiatric holding in the ED escalated adding to increased wait times and causing patient satisfaction and safety concerns. Emergency nurse driven teams used innovative practices of subletting spaces external to the ED to not only decompress the ED but increase ED throughput, outcomes and patient satisfaction.<br/><br/>Design: Evidence based project accomplished as a QI initiative. The two teams began with a barrier analysis and developed improvement actions addressing each. The hospital PRIDE model for improvement was applied using rapid cycle improvement techniques which utilize successive small experiments of change, PDSAs. Jean Watson’s Theory which guides the Professional Practice Model guided the team in the caritas approach to decompressing the ED leading and increasing patient satisfaction and patient outcomes. <br/><br/>Setting: 527-bed Acute Care Magnet Designated Hospital with a 33-bed Level 2 Emergency Department<br/><br/>Participants: ED direct care nurses and management, Center for Psychiatry (CFP) staff and management, ED physicians, Psychiatrists, Administration, QI Facilitators and key collaborative members from all departments across the organization. <br/><br/>Methods: Two multidisciplinary teams were developed. The first team focused on ways to decrease psychiatric holding in the ED. The second team focused on processes for sharing space external to the ED to deliver care to an increasing ED patient population. The teams met biweekly or more often as needed to review data pertinent to their objectives and conducted many small experiments of change. A few examples include communication and hand off reports for use between the ED and CFP, triage and transportation between the areas, staffing allocation, resources and equipment, and medication administration. The data was used to drive process change and improvement. Many experiments required pilot studies that often led to lasting change. <br/><br/>Results/Outcome: An average of approximately 60 patients per month utilize the Transitional Care Area (TCA) decompressing and saving the ED an average of 560 hours. The Extended Care Area (ECA) which operated only hours per week in its pilot stage now operates 60 hours per week serving approximately 35 patients per day. The development of these teams helped drive additional positive outcomes. The rate of patients leaving without being seen reduced to 1.4% in December with an average volume of 167 patients per day. Patient satisfaction for the same period was at the 82nd percentile. <br/><br/>Implications: Process change and nurse driven innovation can help make the difference between ED flow and virtual standstill. ED direct care nurses working interdepartmentally to lead improvement initiatives leads to better ED patient satisfaction and outcomes and ultimately to the decompression of the ED and increased ED throughput. <br/><br/>The Four Key Drivers to Success are: 1. Communication: Open, honest, collegial relationships <br/>2. Collaboration: Team-centered approach to experiments of change 3. Commitment: Accept setbacks, stay positive, and recognize opportunities 4. Care: Patient centered care<br/><br/><br/>en_GB
dc.date.available2011-12-21T12:47:03Z-
dc.date.issued2011-12-21T12:47:03Z-
dc.date.accessioned2011-12-21T12:47:03Z-
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