Signs of Severity (SOS) ED Escalation Guide: Bridging the Experience Gap.

INTRODUCTION: This study evaluated the introduction of an ED Escalation Guide (EDEG) as an early warning system for the many new graduate nurses in the emergency department. The EDEG is a chart that provides ED-appropriate parameters to prioritize both vital signs and critical symptoms. Scenario quizzes were used to evaluate its usefulness. METHODS: Comparative quizzes that required prioritizing the urgency of patient symptoms were given to emergency nurses with varying levels of experience, with and without the use of the EDEG. The quizzes, with scenarios adapted from the Emergency Severity Index (ESI) Handbook, were given to ED RNs 1 week apart; the second quiz included availability of the EDEG. Scores were compared based on demographic data that included years of ED experience and clinical expertise. RESULTS: RNs with less than 1 year of ED experience showed a 29% improvement in scenario scores with use of the EDEG. Those with more experience had similar scores with and without the availability of the guide, but increasing experience led to higher scores. A log kept by new emergency nurses using the EDEG showed accuracy and greater confidence in notifying ED physicians. DISCUSSION: RNs with less than 1 year of ED experience might not recognize or report critical symptoms without a guide. The EDEG helps new emergency nurses to prioritize the urgency of clinical symptoms better and gives them the confidence to report these clinical symptoms. Early warning systems, such as the EDEG, can be valuable tools for inexperienced emergency nurses.

Emergency Nurse Transport of Telemetry Patients: Benefits and Drawbacks.

PROBLEM: Emergency nurse-accompanied telemetry transport on admission to the hospital is a common practice. Potential drawbacks include inefficient use of nursing resources, unnecessary telemetry transports, and disruption of care for remaining ED patients. METHODS: This was a 2-part descriptive quality improvement study using retrospective chart review and prospective documentation of patient transports. Charts were selected by American Heart Association Practice Standards for ECG Monitoring to classify transported telemetry patients into 3 categories. Patient characteristics and adverse events were assessed. Prospectively, the length of transport time and the number and severity of patients the transport nurse left in the emergency department were also recorded. RESULTS: Zero adverse events occurred during any transport. Transport time ranged from 5 to 38 minutes, with a mean of 16.5 minutes. The normal patient ratio increased for nursing staff remaining in the emergency department for the period of the transport, with 74% of patients left in the emergency department classified into high-risk Emergency Severity Index categories 1 and 2. IMPLICATIONS FOR PRACTICE: Findings provided evidence that low-risk telemetry patients had minimal chance of adverse events during transport and highlighted added risks for the remaining emergency patients. Alternative models and interventions are needed to identify appropriate patients for telemetry transport, assign appropriate staff such as licensed paramedics for transport, and evaluate alternative models of nursing care and teamwork in the emergency department.