Nurse First a New Process in One Community Hospital
Anne Marie Tomaski, MS, RN, CNS, CEN, SANE; Colleen Bouyea-Essency, BSN, RN, CEN
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Session C presented Thursday, September 14, 2017
Purpose: If a patient is presenting to the Emergency Department (ED) for treatment of a laceration of a finger or acute chest pain, the experience can be an alarming situation. ED visits have increased over 35%, which has created a stressful environment because the patient census cannot be accommodated. These circumstances have placed ambulatory patients presenting for treatment at risk. The patient who leaves without being seen (LWOBS) has increased to 3.8% at this one community hospital and door to EKG time has also increased to 12 minutes. THe mean overall patient satisfaction score was 83.7% The situation must be dealt with. The purpose of this project was to develop a Nurse First program to address the LWOBS and the Door to EKG time.
Design: In September of 2016, a multidisciplinary taskforce convened to examine existing practice and to offer an evidence-based solution to this quality and safety problem.
Setting: The hospital included in this project is a general medical and surgical urban community hospital with 487 beds. This community hospital has 23,340 admissions and 56,409 ED visits annually.
Participants/Subjects: Project participants included registered nurses and patient care techs in the ED as well as the ambulatory patients presenting for treatment during the project time period of October 16th 2016 to November 16th 2016.
Methods: The committee concluded that there was the need to develop a First Nurse program. To effectively and efficiently implement this program, a literature review was conducted to determine best practices. In addition, webinars about the Nurse First program were attended by nurses from the taskforce. Program planning and implementation commenced in 2016. The goals and expected outcomes were written. Staff were educated and the pilot program went into effect on October 16, 2016. The purpose of this program was to improve the patient experience with arrival in ED. The intent was to decrease the LWOBS by providing immediate contact with an RN and to improve Door to EKG time. After 4 weeks, the data regarding LWOBS and the Door to EKG time were compared. Themean patient satisfaction scores were also compared.
Results/Outcomes: The following data was reviewed at the end of the four week trial. The LWOBS numbers were 4 patients which was 2.8% and a decrease of 1%. The Door to EKG time was 9 minutes which was a decrease of 3 minutes. As a result, enhanced communication with patients in the waiting room improved the patient experience to 87.7% Patients wre encouraged to remain until the medical screening exam was completed. A triage tech performed the EKG as soon as the patient met the criteria. This overall program improved care.
Implications: The trial was successful, so the Nurse First program was instituted on a continuous basis. The data will continue to be monitored and evaluated. If the data remains positive, the triage area will be renovated to include an area for the Nurse First position. Any negative responses will be evaluated on an individual basis in order to keep a positive patient experience with high quality care.
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