Patient arrival: A pivotal point in emergency care
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Tracie Henderson, RN MED BSN CEN; Michele Samsa, BSN, RN, CEN
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Poster presentation
Session E presented Tuesday, October 1, 10:00-11:00 am
Purpose: The purpose of this process change is to provide a rapid assessment of patients arriving to the Emergency Department (ED) through the front door while reducing door to provider times and decreasing patients leaving without a medical screening. Upon arrival to an Emergency Department, proper patient screening is pivotal. Arriving patients are greeted by a Pivot Registered Nurse (RN), immediately, who utilizes clinical judgement to assess and properly place patients prior to formal triage.
Design: A quality improvement process, utilizing evidence based practice, to promote the rapid and safe care of patients presenting to the ED.
Setting: The setting for this process change is a community hospital that evaluates approximately 53,000 patients per year. Nearly 95% of the ED patients arrive through the front door. The facility is a teaching hospital with a residency program and utilizes independent midlevel practitioners for patient evaluation, in additional, to the ED physician.
Participants/Subjects: The participants in the process include: all patients arriving to the ED by the front door, the Nurse Manager, Assistant Nursing Manager, Clinical Resources Specialist, Unit Advisory Council consisting of a multidisciplinary team of ED staff, ED registration staff and Documentation Specialist.
Methods: The participants noted a delay in door to provider times and the need to change the process for the best patient outcomes. Process mapping was conducted to utilize the ideal practice change to improve patient assessment, flow and outcomes. Education and algorithm review was conducted with the UAC for recommendations and approval. Training was completed by Documentation Specialists to enable RN staff to quickly register the arriving ED patients. Clinical expertise is vital in quick accurate assessment of ED patients. Nurses are chosen for their experience and clinical competence. A 30-day trial was conducted with the pivot nurse being placed in the entrance of the ED lobby. The pivot nurse identifies themselves to the patients to promote the patient’s sense of security. The RN obtains the chief complaint and assesses the patient based on appearance and clinical judgment while completing a quick registration. The RN communicates with the ED team lead and triage nurse to properly place the patients and identify sicker patients quickly for best patient outcomes. The RN can accurately pivot patients with limited information, assigning the right patients to the right places safely and efficiently, to best utilize limited space and resources. This process promotes decrease door to provider times and a reduction patient’s leaving without a medical screening.
Results/Outcomes: The outcomes include a reduction in the patients leaving without a medical screening from 3.9% in January 2017 to a consistent reduction of less the 1% during the trial period. Current results: 0.6% January – September 2018. Additionally, door to provider has decreased from 26 minutes in January - April 2017 to 15 minutes from January - September 2018. Patient response has been positive as evidence patient and staff rounding and patient surveys.
Implications: Following the successful results of the pivot nurse during the 30-day trial, the process was adapted for the peak times of patient arrival in the ED.
Type | Poster |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Pivot Nurse; Rapid Triage; Decreased Door-to-Provider |
Name | Emergency Nursing 2019 |
Host | Emergency Nurses Association |
Location | Austin, Texas, USA |
Date | 2019 |
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