Reduced Emergency Department Length of Stay and Proportion of Patients Who Left Without Being Seen Following Implementation of an Interprofessional Vertical Flow Track With Pivot Triage: A Retrospective Pre-/Postintervention Evaluation.

Our objective was to assess change in length of stay and patients who left without being seen following implementation of a pivot triage and interprofessional vertical flow track process at a midwestern academic medical center emergency department. The intervention leveraged an existing interprofessional staffing model including a registered nurse and a paramedic to staff a vertical flow track daily from 1100 to 2300. Pre- and postintervention data were retrospectively abstracted from the electronic charting software. Outcomes included emergency department length of stay and percentage of patients leaving without being seen. Visits for patients during the postintervention period (May 10, 2019, to August 31, 2019) were compared with a corresponding preintervention time period 1 year prior (May 10, 2018, to August 31, 2018). The percentage of patients routed to the vertical flow track increased from 5% to 22% following the process intervention. Median emergency department length of stay decreased from 199 (interquartile range [IQR]: 129-282) to 159 (IQR: 98-232) min. The percentage of patients leaving without being seen decreased from 2.9% to 0.5%; between 1100 and 2300, these changes were more pronounced. Odds of a patient experiencing emergency department length of stay under 180 min increased nearly twofold (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.79-2.08) and odds that a patient stayed to be seen by a medical professional increased sixfold (OR: 5.94, 95% CI: 4.08-8.63). Overall, more than 20% of patients were routed through the vertical flow track following the process change. Implementation of an emergency department pivot triage approach with a dedicated interprofessional vertical flow track was associated with significantly shorter emergency department length of stay and reduced patients leaving without being seen.

Assessment of Clinical Alarms Influencing Nurses' Perceptions of Alarm Fatigue.

BACKGROUND: Excessive clinical alarms have inundated health care for years. Multiple governing bodies, organizations, and facilities have deemed alarm management a priority. Alarm management is a multifaceted problem that affects all health care organizations and clinical staff, especially those in critical care units. Ultimately, the lack of knowledge regarding nurses' perceptions to alarm management and alarm fatigue creates patient safety chiasms. OBJECTIVES: The purpose of this quality improvement project was to understand nurses' perceptions of alarm fatigue (utilizing the Healthcare Technology Foundation's Clinical Alarms Committee Survey) while implementing interventions that improve patient safety. METHODS: The design of this qualitative study is an electronically distributed survey to 31 nurses who work in critical care. The Healthcare Technology Foundation clinical alarms survey has 36 questions with various answering strategies distributed (with permission) via e-mail access by BlueQ through Creighton University. RESULTS: Twenty-six respondents (n = 26) completed the survey, with 42% being intensive care unit nurses and 58% being progressive care unit nurses. The majority of nurses (n = 23, 88%) agreed that nuisance alarms occur frequently and disrupt patient care (n = 25, 96%). A lack of standardized method was noted to alarm management and parameter changes. Multiple patterns emerged that initiated the need for further examination and improvement. DISCUSSION: Following the survey, themes emerged, and changes were implemented including the following: an alarm management policy was created, tools were provided to staff for easy usage, staff were educated using hands-on practice at an annual training summit, and sustainability was created through continuation of alarm management assessment and improvement.

Community Lay Worker Guided Home-Based Monitoring Program for Hypertension Control.

Purpose: The purpose of this study was to determine the incidence of hypertension (HTN), compare clinic versus home visit blood pressure (BP) control, and examine the feasibility of home BP monitoring in a vulnerable adult population. Significance: HTN control continues to be an unmet health maintenance challenge across America. This project used a community lay worker (CLW) to guide individuals in a home BP monitoring program for HTN control. Results: Individuals who were educated in monitoring BP at home significantly reduced their systolic BP. Participants validated that this method was effective in meeting their needs for BP control.

Preventing Progression of Post-Thrombotic Syndrome for Patients Post-Deep Vein Thrombosis.

Post-thrombotic syndrome is a chronic condition that develops in up to 50% of patients with acute deep vein thrombosis. Its burden includes increased costs, decreased quality of life, and decreased personal productivity.

Shared governance in a clinic system.

Shared governance in health care empowers nurses to share in the decision-making process, which results in decentralized management and collective accountability. Share governance practices have been present in hospitals since the late 1970s. However, shared governance in ambulatory care clinics has not been well established. The subjects of this quality project included staff and administrative nurses in a clinic system. The stakeholder committee chose what model of shared governance to implement and educated clinic staff. The Index of Professional Nursing Governance measured a shared governance score pre- and postimplementation of the Clinic Nursing Council. The Clinic Nursing Council met bimonthly for 3 months during this project to discuss issues and make decisions related to nursing staff. The Index of Professional Nursing Governance scores indicated traditional governance pre- and postimplementation of the Clinic Nursing Council, which is to be expected. The stakeholder committee was beneficial to the initial implementation process and facilitated staff nurse involvement. Shared governance is an evolutionary process that develops empowered nurses and nurse leaders.

Development of a guideline for treatment of deep and superficial venous thrombosis in the emergency department.

Patients with DVT, aged 45.64 years, often present to the ED, with an annual cost of $1.5-$3.2 billion per year. This paper describes the process used to implement an evidence-based guideline on deep venous thrombosis (DVT) for the emergency department (ED). Specific aims were to (a) conduct an organizational assessment of DVT treatment practices; (b) compare organizational results with evidence-based treatment guidelines; (c) develop recommendations for the treatment of DVT for ED discharge; and (d) conduct an interdisciplinary evaluation of the evidence-based guideline. A retrospective review of 149 records of adults in an urban Midwestern ED in 2010 was undertaken. Differences in provider practices were identified. A guideline was developed that included clinical management, social/financial concerns, patient education, anticoagulation monitoring, and outpatient follow-up. Implementation and evaluation were accomplished through electronic and paper communication, medical record monitoring, and patient call back. Evaluation also included simulation exercises with an interdisciplinary team.

Incorporating self-efficacy and interpersonal support in an intervention to increase physical activity in older women.

PURPOSE: To compare the efficacy of five versus one session of Behavioral Counseling in a 12-week intervention to increase self-efficacy and family and friend support for activity, and examine self-efficacy and support as mediators of activity among 46 urban women. METHODS: A randomized, controlled trial conducted during 2004 in Omaha, Nebraska. Outcomes were analyzed with Repeated Measures-ANOVA and path analysis. FINDINGS: No significant change was observed in self-efficacy in the five-session group, but a significant decrease was observed in the one-session group (p = .005). Family and friend support increased significantly in the five-session group (p < .001, p = .019). The intervention effect on activity was mediated through change in self-efficacy and family support. CONCLUSIONS: Five behavioral counseling sessions maintained self-efficacy and increased family and friend support although the intervention did not directly affect activity. IMPLICATIONS: The intervention can be replicated within various community settings.

Physical activity counseling for older women.

Physical inactivity is a major factor in increasing women's risk for chronic disease, disability, and premature mortality. This study compared the effectiveness of five behavioral counseling (BC) sessions with a comparison group receiving one BC session based on the five A's (ask, advise, assist, arrange, and agree) to increase moderate-intensity physical activity, muscle strengthening, and stretching activity. The health promotion model provided the framework for the intervention. A pretest/posttest comparison group design was used, with random assignment of 46 women recruited from an urban midwestern community. A significant group interaction was found only for cardiorespiratory fitness (p < .001). Significant time effects were found (p < .001) for both groups in increasing handgrip, leg strength, and flexibility. BC is a promising intervention to achieve physical activity behavior change with older women.