Setting Best Practice: Realizing Synergy, Culture Change and Community Outreach

2.50
Hdl Handle:
http://hdl.handle.net/10755/324172
Category:
Abstract
Type:
Presentation
Title:
Setting Best Practice: Realizing Synergy, Culture Change and Community Outreach
Author(s):
Start, Rachel; Wilson, Lisa; Reddy, Tonya; Mayer, Karen
Author Details:
Rachel Start, MSN, RN, email: rachel_start@rush.edu; Tonya Reddy, RN, APN/APN; Karen Mayer, MSN, RN, NEA-BC, FACHE; Lisa Wilson, BSN, RN, NE-BC
Abstract:
Evidence-based Practice Abstract Purpose: The Institute of Medicine (IOM) Report entitled “The Future of Emergency Care in the United States Health System” (2006) identified overcrowding and inaccuracy of triage acuity level as being a worsening crisis that occurs daily in most emergency departments. A small 100 bed community hospital, with many geographical and resource opportunities sought to address these vital issues by seeking to change culture, recruit Advanced Practice Nurses(APN), implement new triage acuity measurement processes and proactively address high risk community needs. Design: A comprehensive redesign and performance improvement plan was initiated by the Emergency Department’s (ED)APN and presented to hospital administration in collaboration with the Chief Nursing Officer and ED Unit Director(UD). Setting: A 100- bed community hospital ED which had previously suffered recurrent managerial and staff turnover with subsequent poor patient outcomes. Additionally, this hospital as a whole had not previously employed any APNs or been overly engaged in staff empowerment, culture change or community outreach. Participants/Subjects: Participants in this performance improvement plan were executive administration at the hospital, the UD and RN staff in the ED and a newly hired APN. Outcomes will show evidence that the subjects in this project were the patients of the ED who over a period of 2 years experienced a radical shift in the quality and efficiency of care as well as the health of the culture and environment as a whole. Methods: Measurements of this redesign were as follows: % of patients that left the ED without being seen (LWOS), time measurement of door to inpatient bed(DIB), door to discharge(DD) and door to provider(DP), NP practice measurements, nursing staff engagement and turnover, core measure population readmission rates, census, market share and patient satisfaction measures. In collaboration with the CNO and ED UD, the first APN was hired to the ED. This APN introduced a plan for redesign, implementation of a Fast Track (FT), full implementation of Emergency Severity Index for more rapid, accurate triage. Education and staff led interventions to create a patient centered culture led to a healthier environment. Geographical redesign was included to promote a calmer environment for less acute patients with more direct access for higher acuity patients. Finally, as a result of staff seeking to meet needs of the community several patient education classes are held per month and free to the community, the hospital has aligned with the PADS program for the homeless as well as the Infant Welfare Society in high risk neighborhoods nearby. Results/Outcomes: % LWOS in 2009 was 2.6%, now .4%, DIB was 409 minutes, now 215 minutes, DD was 162 minutes, now 69 minutes, DP was 62 minutes, now 22 minutes. Patient satisfaction scores were below 80% mean and now 87.2%. Census has increased 7% per year for the last 3 years and the ED has the largest market share in the region. Currently 16 APNs are employed in the ED. Implications: Healthcare today demands more effective, patient centered, efficient processes that promote health and focus on the continuity of patient care with emphasis on the outpatient arena. EDs play a key role in this mandate. The redesign discussed in this abstract will identify key interventions that have been proven successful to assist other patient care centers in this imperative.
Keywords:
ED Redesign; Community needs; Triage
Repository Posting Date:
4-Aug-2014
Date of Publication:
4-Aug-2014
Conference Date:
2014
Conference Name:
2014 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Phoenix, Arizona USA
Description:
2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleSetting Best Practice: Realizing Synergy, Culture Change and Community Outreachen_GB
dc.contributor.authorStart, Rachelen_GB
dc.contributor.authorWilson, Lisaen_GB
dc.contributor.authorReddy, Tonyaen_GB
dc.contributor.authorMayer, Karenen_GB
dc.author.detailsRachel Start, MSN, RN, email: rachel_start@rush.edu; Tonya Reddy, RN, APN/APN; Karen Mayer, MSN, RN, NEA-BC, FACHE; Lisa Wilson, BSN, RN, NE-BCen_GB
dc.identifier.urihttp://hdl.handle.net/10755/324172-
dc.description.abstractEvidence-based Practice Abstract Purpose: The Institute of Medicine (IOM) Report entitled “The Future of Emergency Care in the United States Health System” (2006) identified overcrowding and inaccuracy of triage acuity level as being a worsening crisis that occurs daily in most emergency departments. A small 100 bed community hospital, with many geographical and resource opportunities sought to address these vital issues by seeking to change culture, recruit Advanced Practice Nurses(APN), implement new triage acuity measurement processes and proactively address high risk community needs. Design: A comprehensive redesign and performance improvement plan was initiated by the Emergency Department’s (ED)APN and presented to hospital administration in collaboration with the Chief Nursing Officer and ED Unit Director(UD). Setting: A 100- bed community hospital ED which had previously suffered recurrent managerial and staff turnover with subsequent poor patient outcomes. Additionally, this hospital as a whole had not previously employed any APNs or been overly engaged in staff empowerment, culture change or community outreach. Participants/Subjects: Participants in this performance improvement plan were executive administration at the hospital, the UD and RN staff in the ED and a newly hired APN. Outcomes will show evidence that the subjects in this project were the patients of the ED who over a period of 2 years experienced a radical shift in the quality and efficiency of care as well as the health of the culture and environment as a whole. Methods: Measurements of this redesign were as follows: % of patients that left the ED without being seen (LWOS), time measurement of door to inpatient bed(DIB), door to discharge(DD) and door to provider(DP), NP practice measurements, nursing staff engagement and turnover, core measure population readmission rates, census, market share and patient satisfaction measures. In collaboration with the CNO and ED UD, the first APN was hired to the ED. This APN introduced a plan for redesign, implementation of a Fast Track (FT), full implementation of Emergency Severity Index for more rapid, accurate triage. Education and staff led interventions to create a patient centered culture led to a healthier environment. Geographical redesign was included to promote a calmer environment for less acute patients with more direct access for higher acuity patients. Finally, as a result of staff seeking to meet needs of the community several patient education classes are held per month and free to the community, the hospital has aligned with the PADS program for the homeless as well as the Infant Welfare Society in high risk neighborhoods nearby. Results/Outcomes: % LWOS in 2009 was 2.6%, now .4%, DIB was 409 minutes, now 215 minutes, DD was 162 minutes, now 69 minutes, DP was 62 minutes, now 22 minutes. Patient satisfaction scores were below 80% mean and now 87.2%. Census has increased 7% per year for the last 3 years and the ED has the largest market share in the region. Currently 16 APNs are employed in the ED. Implications: Healthcare today demands more effective, patient centered, efficient processes that promote health and focus on the continuity of patient care with emphasis on the outpatient arena. EDs play a key role in this mandate. The redesign discussed in this abstract will identify key interventions that have been proven successful to assist other patient care centers in this imperative.en_GB
dc.subjectED Redesignen_GB
dc.subjectCommunity needsen_GB
dc.subjectTriageen_GB
dc.date.available2014-08-04T13:28:48Z-
dc.date.issued2014-08-04-
dc.date.accessioned2014-08-04T13:28:48Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationPhoenix, Arizona USAen_GB
dc.description2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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