Safe Transport of Telemetry Patients with ED RN's - Unintended Consequences

Abstract

Research Abstract: Purpose: Maintaining safe transport of telemetry patients from the Emergency Department (ED) by having an ED RN accompany them has become a priority in recent years. Unfortunately, many ED’s do not have the resources to have an extra transport nurse available. This study assessed the effectiveness of RN transport and evaluated unintended consequences for patients remaining in the ED. Design: The two-part study consisted of a comparative retrospective review of 330 admitted telemetry patient charts classifying patients into one of three American Heart Association (AHA) categories, and a prospective study that collected data using 214 transport “Tickets to Ride” provided by ED RN’s. Results were analyzed using frequencies and percentages. Setting: The study was done in a suburban, 80 bed adult ED, set in a 550 bed non-profit community hospital, averaging over 900 telemetry admissions monthly. Participants/Subjects: 330 telemetry charts were reviewed retrospectively. ED RN’s documented demographic data on 214 transported telemetry patients, and on patients left in the ED during transport. Methods: The retrospective review used AHA Practice Standards for ECG Monitoring to classify patients transported to Telemetry, Step-down, & ICU into three categories based on indications for telemetry. Charts were reviewed for major adverse events during transfer. The prospective review documented length of transport time and destination, number and Emergency Severity Index (ESI) levels of patients left in the ED, and nurse receiving report (resource or team member). Results/Outcomes: One third (33%) of transported patients were identified as AHA Category 1, with definite indications for telemetry. The other 67 % were evenly divided between Categories 2 and 3, with telemetry either not essential or not at all indicated. Zero adverse events occurred during any transport. Transport time ranged from 5 – 38 minutes (M =16.5 minutes). The majority of ED patients (93.5%) were transported to telemetry units; 6.5% were transported to ICU/Step-down. ED nurses caring for 3-4 patients assumed care for an average of 2.3 extra patients, increasing the normal 4:1 patient ratio to 6 or 7:1 for the period of the transport. Two thirds (67%) of patients left in the ED were classified into ESI high risk categories 1 or 2. Implications: Calculations showed 8.8 of 263 nursing hours daily in ED telemetry teams were spent solely on transport. The effects of the transport are essentially doubled, as the disruption affects two teams of patients. Quality of care and efficiency can both be affected when the nurse-patient ratio is increased. ED Length of Stay (LOS) and Throughput Core Measures could be improved if a safe solution to the transport issue can be implemented. Our recommendation is the use of improved wireless technology – place the remote telemetry monitor on the patient in the ED, & transport most non-critical patients (AHA categories 2 and 3) to telemetry floors with BLS trained transporters. Communication by hospital portable phones would facilitate emergency care for any rare adverse cardiac event during transport. ED nurses would be available to provide care safely and efficiently for the patients left in the ED.