Slipping through the cracks-detection of sex trafficking in the adult emergency department: An integrative review.

INTRODUCTION: Current research estimates that over 24 million individuals experience human trafficking worldwide. There is a growing prevalence of sex trafficking in the United States. An estimated 87% of trafficked persons visit the emergency department during their captivity. Emergency departments across the United States use differing screening methods for sex trafficking. Current screening tools return a high rate of false negatives, and the appropriate use of tools or standardised lists remains unclear. AIMS: To explore best practices for identifying sex trafficking among adults who visit emergency departments. We sought to answer the practice question: How does the implementation of a multifaceted screening model for sex trafficking, versus the use of a list of standardised screening questions, improve the detection of trafficked persons? METHODS: We conducted an integrative review of articles published after 2016 in PubMed, CINAHL, Embase, SCOPUS, and Web of Science databases. PRISMA checklist and guidelines were used. Whittemore and Knafl's method was used to review the literature. RESULTS: A final selection of 11 articles were reviewed and appraised using the Johns Hopkins nursing evidence-based practice model. The synthesis of evidence yielded four themes: (1) Provider and personnel education; (2) Protocol establishment; (3) Legal consultation; and (4) Multidisciplinary teamwork. CONCLUSION: Through this process, we learned the importance of using multifaceted screening tools for identifying persons who are experiencing sex trafficking. In addition to using multifaceted screening tools, detection is improved when all emergency department personnel receive training on sex trafficking. There is a recognised lack of education on sex trafficking recognition nationwide. RELEVANCE TO CLINICAL PRACTICE: Notably, emergency department nurses play an essential role in sex trafficking identification due to their maximised interaction with patients and the increased perception of trust that patients have with nurses. Steps include the development of an education program to improve recognition. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or drafting of this integrative review.

Audit and Feedback: An Evidence-Based Practice Literature Review of Nursing Report Cards.

BACKGROUND: As more hospitals transition to electronic health records (EHR) and rely on technology to inform practice, what is done with that information is increasingly important. Performance report cards for physicians and nurses are not new, yet there is little recent evidence on nurse-specific audit and feedback. AIM: The aim of the project was to conduct an evidence-based practice (EBP) review to answer the question, "Does implementing an individualized audit and feedback report tool for nurses improve compliance, adherence, and/or performance of nursing tasks?". METHODS: Evidence was gathered from several databases. Reviewers read and appraised articles that answered the EBP question using the Johns Hopkins Nursing EBP Model. Data were then collated to synthesize and generate recommendations. RESULTS: Of the initial 613 unique articles, eight (two research and six quality improvement) were included. Six articles demonstrated improvements while two did not. Articles analyzed nursing documentation (n = 3), tasks or skills (n = 2), and best practice compliance (n = 3). One manuscript utilized an EHR-generated report; all others were completed by hand. Overall, there was not consistent and compelling evidence to support individualized audit and feedback report tools in nursing. However, several themes emerged related to sustainability, timing of feedback, audit, and feedback in the context of quality improvement, and the methods of acquiring and distributing data. LINKING EVIDENCE TO ACTION: The ubiquity and ease of the EHR make providing automated feedback to nurses tempting, yet it is not supported by the literature. More implementation science research is needed to explore audit and feedback reports in nursing. This article adds to the literature by highlighting a significant lack of consistent and compelling positive results from the well-established quality improvement strategy of audit and feedback in the nursing population. The absence of good data is as telling as its presence.

Quality Improvement in the Emergency Department: A Project to Reduce Door-to-Electrocardiography Times for Patients Presenting With Chest Pain.

INTRODUCTION: The American Heart Association/American College of Cardiology guidelines recommend obtaining electrocardiography for patients who present to the emergency department with chest pain in less than 10 minutes of arrival. Reducing door-to-electrocardiography time is an important step in adhering to the recommended door-to-balloon times (≤ 90 minutes) for patients who present with ST-segment elevation myocardial infarction. METHODS: Based on lean sigma principles, a protocol was implemented in an adult emergency department that included deferring nurse triage for patients with complaints of chest pain, chest tightness, and chest pressure and providing them with a red heart symbol as an indicator for clinical technicians to prioritize their electrocardiography order. Pre- and postintervention data were collected over a 12-month period. RESULTS: Before the intervention, the mean door-to-electrocardiography time was 17 minutes for patients with chest pain (n = 893). After the intervention, the mean door-to-electrocardiography time for patients with chest pain significantly decreased to 7 minutes (n = 1,057) (t = 10.47, P ≤ 0.001). Initially, the percentage of compliance with door-to-electrocardiography standard of 10 minutes was 31% and improved to 83% after implementation of the new protocol. DISCUSSION: Implementation of the optimized door-to-electrocardiography protocol decreased the time for obtaining diagnostics and improved compliance with the American Heart Association/American College of Cardiology guidelines, potentially decreasing door-to-balloon times for patients who presented with ST-segment elevation myocardial infarction.

Increasing Nursing Scholarship Through Dedicated Human Resources: Creating a Culture of Nursing Inquiry.

As the role of nursing grows in healthcare, the engagement of frontline nurses in evidence-based practice, quality improvement, and research is becoming the expectation and no longer the exception. Clinical nurses are in a unique position to inform and implement scholarly projects. The purpose of this staff development and capacity-building project was to increase the output of scholarly work among frontline nurses through the formalization of nursing inquiry support via designated nursing inquiry project coordinators.

Outcomes of an Innovative Evidence-Based Practice Project: Building a Difficult-Access Team in the Emergency Department.

PROBLEM: Difficult venous access is a common problem in health care-especially in the emergency setting-that relies on quick diagnostics to differentiate patient acuities and administer critical medications. The creation of a dedicated team to address difficult venous access (DVA) is a possible solution to the problems of delayed venous access, yet no studies have been published on implementing such a team in the emergency department. METHODS: This was a quasi-experimental study in an urban emergency department. Researchers performed chart audits of staff-identified patients with DVA to gather baseline data. A DVA team was subsequently implemented 16 hours a day, 7 days a week. Data were recorded on patients referred to the team and included time, number of IV attempts, and patient characteristics. RESULTS: Baseline data were collected on 53 patients, and postintervention data included 135 patients. The implementation of a DVA team decreased the mean lab order-to-lab completion time by 115 minutes (P < 0.0001). Decreases in the number of attempts were not statistically significant. Patients requiring increased numbers of IV attempts also had many common characteristics including history of multiple attempts, poor skin quality, and IV drug use. DISCUSSION: The use of a dedicated team for DVA reduces the lag time from physician orders to actionable diagnostics or administration of medication. A dedicated DVA technician is a concrete solution to threats of patient safety, as well as ED crowding, and has the potential to affect both patient- and department-level care.

Establishing a Dedicated Difficult Vascular Access Team in the Emergency Department: A Needs Assessment.

Peripheral vascular access is one of the most common procedures performed in emergency departments across the United States. Successful venipuncture is critical in providing timely diagnosis and treatments for patients. The aim of this article is to describe a needs assessment performed in a level-one academic emergency department to establish the need for a dedicated team for patients with difficult vascular access. Results from this assessment suggest that difficult vascular access represents tangible threats to patient safety and increased use of resources.

Increasing the Number of Certified Registered Nurses in an Emergency Department: A Cohort Program Implementation.

Nationally, hospital emergency departments are met with challenges because of increasing patient demands, overcrowding, and the need to protect patient safety. It is imperative that frontline emergency department nurses are prepared to meet the complex needs of diverse patient populations by having appropriate continuing education, training, and institutional resources. Professional certification is associated with improved patient safety, higher organizational performance scores, professional growth, and credibility among nurses. The purpose of this article is to describe the process and outcome of a nursing professional development-practitioner-led intervention to promote professional certification among nurses in an urban adult emergency department while reducing overall cost of institutional support for certification preparation.