Improving PACU Throughput Using an Electronic Dashboard: A Quality Improvement Initiative.

PURPOSE: Patients boarding in a 14-bed postanesthesia care unit (PACU) impacted throughput in a large university hospital in West Virginia. The PACU and operating room (OR) boarder rate in 2019 was 12% (n = 1241) and 5% (n = 503), respectively. The purpose of this initiative was to improve PACU throughput by developing an efficient and evidence-based handoff communication process between the PACU and the medical-surgical floors. DESIGN: The design of the project was evidence-based quality improvement. METHODS: An interprofessional team created a nursing patient dashboard in the electronic medical record to be used during handoff communication between the PACU and medical-surgical floor nurses. The dashboard displayed real-time vital signs, patient history, medications, and laboratory results. When the patient met Aldrete score requirements for transfer, PACU nurses notified the floor that the patient was ready for transfer. After allowing 20 minutes for the floor nurse to view the dashboard, the PACU nurse and floor nurse spoke on the phone to discuss any outstanding questions. PACU and OR boarder rates were obtained from the electronic medical record 12 months before and after implementing the nursing patient dashboard. User feedback was gathered via plan-do-study-act cycles, posters, and interviews. FINDINGS: The electronic dashboard was a successful strategy to improve handoff communication between the PACU and receiving units. The dashboard was accepted by the staff with 70% (n = 24) of the comments being positive. A significant decrease in the number of PACU (χ2(1, n = 20,608) =122.63, P < .00001) and OR boarding (χ2 (1, n = 20,283) =14.55, P = .000136) of patients was found in the C-year compared to 2019. For patients who were boarded in the PACU, no significant difference in PACU delay duration was found (t(11) =1.49, P = .149) with the mean in 2019 of 166.96 (SD = 68.38) and the C-Year mean 132.84 (SD = 39.74). For patients who boarded in the OR, there was a significant difference (t(11) =15.590162, P <.00001) between groups for average duration of boarding with the mean in 2019 of 19.06 minutes (SD = 3.72) compared to 1.62 (SD = 1.1) in C-year. However, in July 2020 the PACU intermittently opened 2 flexible beds when the PACU was full, suggesting that OR boarding was not a reliable measure, but PACU boarding remained an accurate measure. CONCLUSIONS: The findings of this evidence-based quality improvement project demonstrated the usefulness of an electronic dashboard tool combined with verbal report to improve patient throughput by decreasing the number of patients boarding in the PACU.

Multidisciplinary performance improvement team for reducing health care-associated Clostridium difficile infection.

Clostridium difficile is the most frequent cause of health care-associated diarrhea and is a significant cause of morbidity and mortality. It is also associated with a considerable financial burden. A concerted multidisciplinary approach is required for prevention.

Evaluation of a program to increase evidence-based practice change.

OBJECTIVE: The study evaluated a nursing research program designed to achieve systematic evidence-based practice change. Specifically, change in nurse attitudes about use of research and research conduct, practice change projects, and nurse participation in research-related activities were evaluated. BACKGROUND: Evidence indicates that successful evidence-based practice change in an organization requires senior leadership support and a systematic program for practice change. Evaluation of program effectiveness provides evidence about opportunities for further improvement. METHODS: Quantitative evaluation used a pretest-posttest design. The site was an academic medical center in rural West Virginia. Participants were registered nurses from all inpatients units, perioperative services, and emergency departments. Surveys used Alcock et al's Staff Nurses and Research Activities scale. Descriptive evaluation included the number of nurses who attended the workshop, practice change projects, scholarly products disseminated, and outcome of a Magnet review. RESULTS: First, knowledge about the availability of support services increased between 1999 and 2002 and was associated with higher attitude scores about research and research utilization. Second, registered nurses who reported participating in research-related activities had more positive scores on all attitudes than registered nurses who reported not participating. CONCLUSIONS: Nurse leaders may improve participation and attitudes about research and research utilization by internally marketing the support available for research-related activities.