Transforming Care in an Inner City University's Emergency Department Waiting Room

2.50
Hdl Handle:
http://hdl.handle.net/10755/306548
Category:
Abstract
Type:
Poster
Title:
Transforming Care in an Inner City University's Emergency Department Waiting Room
Author(s):
Allen, Sarah; Venella, Jeanne J.; Davis, Annette
Lead Author STTI Affiliation:
Non-member
Author Details:
Sarah Allen, BSN, RN, sara.allen@uphs.upenn.edu; Jeanne J. Venella, DNP, MS, RN, CEN, CPEN; Annette Davis, BSN, RN
Abstract:

Evidence-based Practice Abstract

Purpose: At all times, without variations, a Level One Emergency Trauma Center waiting room can accommodate a plethora of high acuity patients and distraught family members. The volatile potential of this population demands additional medical staff presence in the waiting to facilitate faster throughput times, decrease left without being seen rates, and alleviate triage interruptions. The goal was to provide immediate assessment by nursing staff to patients on arrival, identify patients who require immediate medical attention and provide quality of care in a timely manner.

Design: The Greeter RN initiative began as a Quality Improvement Project to immediately identify critically ill patients, alleviate triage interruptions and increase patient throughput time through proper patient disbursement thus enhancing overall patient/family care.

Setting: Inner city, University Emergency Department, level 1 trauma center with annual visits exceeding 60,000.

Participants/Subjects: All patients and family members that enter the waiting room without limitations to sex, ethnicity, age and demographic background.

Methods: The desire for change resulted from concerns by ED administration and nursing staff regarding prolonged wait times, increasing left without treatment (LWT) rates, overall patient safety, and increasing staff frustrations.

Results/Outcomes: By placing a nurse at the point of patient arrival we decreased the number of triage interruptions by pregnant patients (needing transportation to the Labor Floor) as well as patients and family members inquiring about the triage process. Implementation of this new position and separating patients by acuity increased the overall throughput time in the department by 27% which was significant despite the increase in patient volumes by 70%. Overall, LWT’s decreased by 33% and door to EKG time were reduced from 12 minutes to 7 minutes. The continuous point of contact for an inner city waiting room achieved the goal of transforming care and a higher quality of service.

Implications: In conclusion, the underestimated threshold for crowding in an inner city Level One Trauma center can be managed by the presence of an experienced nurse. The greeter nurse is responsible for communicating with the Charge RN about waiting room issues, prioritizing patients, and potential events. Equally as important the greeter nurse will ensure regulatory and quality standards are met relating to cardiovascular events, brain attacks, pneumonia, and unannounced traumas. Nursing personnel has expressed a great deal of support after being skeptical. The triage nurses feel they devote more attention to the triages at hand. The registration staff is comfortable with a medical professional at the front door to assess patients. Charge nurses rely on the experienced emergency nurse at the front door to promptly communicate when sick patients arrive. Families and patients have expressed comfort that there is a medical professional to speak to in the waiting room, therefore enhancing the patient experience. In addition, fiscal outcomes were positively impacted. The average LWT patient represents a minimum of $500.00 loss for the department per patient. Therefore, retention of these funds provides affordable staffing of the Greeter Nurse Position. These funds also translate into increased funds for new equipment, raises and other costs.

Keywords:
ED Waiting Room
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Ft. Lauderdale, Florida, USA
Description:
2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleTransforming Care in an Inner City University's Emergency Department Waiting Roomen_GB
dc.contributor.authorAllen, Sarahen_GB
dc.contributor.authorVenella, Jeanne J.en_GB
dc.contributor.authorDavis, Annetteen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsSarah Allen, BSN, RN, sara.allen@uphs.upenn.edu; Jeanne J. Venella, DNP, MS, RN, CEN, CPEN; Annette Davis, BSN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306548-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: At all times, without variations, a Level One Emergency Trauma Center waiting room can accommodate a plethora of high acuity patients and distraught family members. The volatile potential of this population demands additional medical staff presence in the waiting to facilitate faster throughput times, decrease left without being seen rates, and alleviate triage interruptions. The goal was to provide immediate assessment by nursing staff to patients on arrival, identify patients who require immediate medical attention and provide quality of care in a timely manner.</p><p>Design: The Greeter RN initiative began as a Quality Improvement Project to immediately identify critically ill patients, alleviate triage interruptions and increase patient throughput time through proper patient disbursement thus enhancing overall patient/family care.</p><p>Setting: Inner city, University Emergency Department, level 1 trauma center with annual visits exceeding 60,000.</p><p>Participants/Subjects: All patients and family members that enter the waiting room without limitations to sex, ethnicity, age and demographic background.</p><p>Methods: The desire for change resulted from concerns by ED administration and nursing staff regarding prolonged wait times, increasing left without treatment (LWT) rates, overall patient safety, and increasing staff frustrations.</p><p>Results/Outcomes: By placing a nurse at the point of patient arrival we decreased the number of triage interruptions by pregnant patients (needing transportation to the Labor Floor) as well as patients and family members inquiring about the triage process. Implementation of this new position and separating patients by acuity increased the overall throughput time in the department by 27% which was significant despite the increase in patient volumes by 70%. Overall, LWT’s decreased by 33% and door to EKG time were reduced from 12 minutes to 7 minutes. The continuous point of contact for an inner city waiting room achieved the goal of transforming care and a higher quality of service.</p><p>Implications: In conclusion, the underestimated threshold for crowding in an inner city Level One Trauma center can be managed by the presence of an experienced nurse. The greeter nurse is responsible for communicating with the Charge RN about waiting room issues, prioritizing patients, and potential events. Equally as important the greeter nurse will ensure regulatory and quality standards are met relating to cardiovascular events, brain attacks, pneumonia, and unannounced traumas. Nursing personnel has expressed a great deal of support after being skeptical. The triage nurses feel they devote more attention to the triages at hand. The registration staff is comfortable with a medical professional at the front door to assess patients. Charge nurses rely on the experienced emergency nurse at the front door to promptly communicate when sick patients arrive. Families and patients have expressed comfort that there is a medical professional to speak to in the waiting room, therefore enhancing the patient experience. In addition, fiscal outcomes were positively impacted. The average LWT patient represents a minimum of $500.00 loss for the department per patient. Therefore, retention of these funds provides affordable staffing of the Greeter Nurse Position. These funds also translate into increased funds for new equipment, raises and other costs.</p>en_GB
dc.subjectED Waiting Roomen_GB
dc.date.available2013-12-09T16:59:35Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T16:59:35Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationFt. Lauderdale, Florida, USAen_GB
dc.description2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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