24.00
Hdl Handle:
http://hdl.handle.net/10755/306580
Category:
Abstract
Type:
Poster
Title:
Registered Nurse Centered Medical Screening Exam Program
Author(s):
Novotny, April; Leckie, Maureen; Carter, Pam
Lead Author STTI Affiliation:
Non-member
Author Details:
April Novotny MSN, RN, CEN, April.novotny@lrmc.com; Maureen Leckie, BSN, RN; Pam Carter, BSN, RN
Abstract:

Evidence-based Practice Abstract

Purpose: Part of the 1986 Emergency Medical Treatment and Labor Act (EMTALA) regulation mandated that every person arriving to an emergency department receive a medical screening examination (MSE) to determine whether an emergency medical condition existed. Centers for Medicare and Medicaid Services (CMS), state that a hospital may designate a non-physician practitioner as the qualified medical person to complete the MSE. Evidence supports registered nurses assessment skills. The purpose of the project was to develop an evidenced-based staff development program for experienced registered nurses gain competency in completion of medical screening exams.

Design: A staff development project designed for registered nurses to gain competency in performing medical screening exams.

Setting: An urban, level 2 trauma center with over 167,000 annual visits.

Participants: Qualified emergency department RN’s were accepted to the MSE program.

Methods: The hospital Board of Directors adopted a resolution determining experienced registered nurses were qualified to perform MSE’s. Requirements included acute care and emergency department experience. A review of available literature on registered nurses assessment and legal ability to perform medical screening examinations was completed. A comprehensive training program was developed. An online training module included an EMTALA review from the American College of Emergency Physicians; emergency nursing patient assessment, as well as hospital specific policy and procedures such as triage standard operating practices and inclusion criteria for Fastracare. Finally a flow map was developed clearly defining the process for patient flow through the medical screening exam. Prior to being approved to perform MSE’s staff members had an observation period to assure consistency of assessment skills.

Results: A core group of 10 nurses were trained starting in July of 2012. The program was initiated in conjunction with the opening of the health systems Family Health Clinic. This joint venture sought to redirect non-emergent patients without adequate funding to the health clinic in an effort to establish a quality medical home for these patients. On average, 2680 patients monthly have been screened by registered nurses since the start of the program. Patients deemed non-emergent are given the option to be seen the same day at the hospital’s family health clinic. A rigorous performance improvement study is performed monthly to assure that patients are screened appropriately. Emergency department physicians, risk management representatives, emergency department leadership and staff nurses are all part of the performance improvement team that audits the medical screening exam process. The error rate for missed emergent conditions is 0%. Chart audits, observations, and audits from the Family Health Clinic have not revealed any missed emergent cases.

Implications: Medical screening exams have been competently completed by trained emergency department registered nurses. Evidence suggests with clear process flows and a comprehensive training program, programs for MSE nurses can be expanded to additional emergency departments. Further evaluation of the program is ongoing to determine if referring non emergent, underinsured and uninsured to a medical home results in a reduction of episodic emergency department care and improved patient outcomes.

Keywords:
RNs and Medical Screening Exams
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and 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.titleRegistered Nurse Centered Medical Screening Exam Programen_GB
dc.contributor.authorNovotny, Aprilen_GB
dc.contributor.authorLeckie, Maureenen_GB
dc.contributor.authorCarter, Pamen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsApril Novotny MSN, RN, CEN, April.novotny@lrmc.com; Maureen Leckie, BSN, RN; Pam Carter, BSN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306580-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: Part of the 1986 Emergency Medical Treatment and Labor Act (EMTALA) regulation mandated that every person arriving to an emergency department receive a medical screening examination (MSE) to determine whether an emergency medical condition existed. Centers for Medicare and Medicaid Services (CMS), state that a hospital may designate a non-physician practitioner as the qualified medical person to complete the MSE. Evidence supports registered nurses assessment skills. The purpose of the project was to develop an evidenced-based staff development program for experienced registered nurses gain competency in completion of medical screening exams.</p><p>Design: A staff development project designed for registered nurses to gain competency in performing medical screening exams.</p><p>Setting: An urban, level 2 trauma center with over 167,000 annual visits.</p><p>Participants: Qualified emergency department RN’s were accepted to the MSE program.</p><p>Methods: The hospital Board of Directors adopted a resolution determining experienced registered nurses were qualified to perform MSE’s. Requirements included acute care and emergency department experience. A review of available literature on registered nurses assessment and legal ability to perform medical screening examinations was completed. A comprehensive training program was developed. An online training module included an EMTALA review from the American College of Emergency Physicians; emergency nursing patient assessment, as well as hospital specific policy and procedures such as triage standard operating practices and inclusion criteria for Fastracare. Finally a flow map was developed clearly defining the process for patient flow through the medical screening exam. Prior to being approved to perform MSE’s staff members had an observation period to assure consistency of assessment skills.</p><p>Results: A core group of 10 nurses were trained starting in July of 2012. The program was initiated in conjunction with the opening of the health systems Family Health Clinic. This joint venture sought to redirect non-emergent patients without adequate funding to the health clinic in an effort to establish a quality medical home for these patients. On average, 2680 patients monthly have been screened by registered nurses since the start of the program. Patients deemed non-emergent are given the option to be seen the same day at the hospital’s family health clinic. A rigorous performance improvement study is performed monthly to assure that patients are screened appropriately. Emergency department physicians, risk management representatives, emergency department leadership and staff nurses are all part of the performance improvement team that audits the medical screening exam process. The error rate for missed emergent conditions is 0%. Chart audits, observations, and audits from the Family Health Clinic have not revealed any missed emergent cases.</p><p>Implications: Medical screening exams have been competently completed by trained emergency department registered nurses. Evidence suggests with clear process flows and a comprehensive training program, programs for MSE nurses can be expanded to additional emergency departments. Further evaluation of the program is ongoing to determine if referring non emergent, underinsured and uninsured to a medical home results in a reduction of episodic emergency department care and improved patient outcomes.</p>en_GB
dc.subjectRNs and Medical Screening Examsen_GB
dc.date.available2013-12-09T17:00:09Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:09Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and 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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