Evidence Based Change: A Protocol to Reduce Ambulance Diversion Using the National Emergency Department Overcrowding Scale Tool
Review TypeFaculty Approved: Degree-based Submission
Repository Posting Date2019-06-04T17:30:54Z
Author(s)Rogers, Kathryn S.
Author DetailsKathryn S. Rogers DNP, RN, NEA-BC, CEN, CPEN, TCRN, CPHQ
Lead Author Sigma AffliationNon-member
TypeDNP Capstone Project
Level of EvidenceQuality Improvement
Research ApproachTranslational Research/Evidence-based Practice
CINAHL HeadingsEmergency Service; Ambulance Diversion; Emergency Service--Administration; Crowding--Prevention and Control; Crowding; Emergency Service--Utilization
Background: Ambulance diversion (AD) occurs when emergency departments (EDs) experience over-demand of available resources and can no longer accept ambulance patients. Current evidence however, shows that AD delays critical care, negatively impacting quality and cost. The purpose of this project was to reduce AD by creating an evidence-based protocol in the ED setting. Methods: Underpinned by Kurt Lewin’s Change Theory and following a Plan Do Check Act model, a healthcare quality improvement team implemented an AD protocol in a busy urban ED. Baseline data was taken from historical hours of AD use and ambulance arrivals over the previous three years. Following a pre-test—post-test design, three year baseline data was compared to data from a 20 week trial using the paired samples t-test. Intervention: An AD protocol was created in the project setting. The protocol used the National Emergency Department Overcrowding Scale tool, with corresponding overcrowding response strategies to make AD decisions. Results: The mean hours of AD fell from 13.10 hours per week to 2.23 hours per week. The mean number of ambulance patients rose from 156 patients per week to 185 patients per week. Conclusion: Measuring ED overcrowding and using the AD protocol, the healthcare quality improvement team successfully reduced AD in their project setting. Additionally, an improved understanding between ED overcrowding and AD emerged. This enhanced understanding may present opportunity for similar projects in other EDs seeking to reduce AD as well.
Degree GrantorNorthern Arizona University
NotesThis work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
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