Improving emergency department time to provider, left-without-treatment rates, and average length of stay.

BACKGROUND: Emergency Department (ED) overcrowding and ensuing concern about patients who leave without treatment have become a mounting national concern. In addition, the Centers for Medicaid and Medicare Services released regulatory standards for EDs requiring reporting of time from initial triage to decision to admit, as well as actual time of admission. OBJECTIVES: To implement an improved ED patient flow process. METHODS: We performed a comparative, pre- and post-intervention ED redesign study evaluating three primary end points between two similar, seasonal time periods. RESULTS: Despite an 11% increase in daily patient volume in 2010, analysis of time to provider pre-ED redesign and post-ED redesign implementation revealed a mean of 126.7 min in 2009 (SD 37.03) vs. a mean of 26.3 min in 2010 (SD 1.17). The p-value was significant at <0.001. Overall ED average length of stay (ALOS) in 2009 was 5.5 h (SD 0.68) and 3.6 h (SD 1.16) in 2010, reflecting a mean reduction in ALOS of 1.9 h. The p-value was significant at <0.01. The proportion of patients who left without treatment (LWOT) also decreased. The proportion of LWOTs during the 2009 study period was 8.7% (95% confidence interval [CI] 6.14-11.26%), compared to 0.2% (95% CI 0.14-0.36%; p < 0.005) in the 2010 study period. Although the overall ED-visit Press Ganey patient-satisfaction scores improved during the 2010 study period, the results were not statistically significant (p < 0.1). CONCLUSION: Our study demonstrated that a tailored ED redesign process can dramatically decrease the time to provider, ALOS, and LWOT rates.

Analysis of staff safety concerns.

The purpose of this project was to translate safety concerns extracted from written survey comments into actionable items. This project then served as the catalyst for resolving a number of significant safety issues in a performance improvement model and helped to create a reliable and efficient process for future thematic reviews.

Saving lives following the expansion of centralized remote telemetry monitoring.

Continuous monitoring of patients throughout the hospital is a desirable method to ensure the continuity of quality care. Hospitals looking to improve the manner in which they maintain such continuity without compromising efficiency must explore the benefits of implementing monitoring technology to its fullest potential. This case study chronicles the journey of a level-one trauma hospital during the expansion of remote wireless telemetry monitoring and the telemetry technician role. The lives saved as a result of this expansion were primarily attributable to the installation of remote wireless telemetry monitoring in the emergency department. The expansion of the telemetry technician role improved not only the quality of the monitoring signal and recognition, but also the ability to identify changes in trended data. The next step for improving care delivery includes the addition of a patient locator system within the facility, which will provide the most accurate information regarding patient location during transfer. Accurately identifying patient location in addition to alerting staff to changes in patient status will ensure that care providers respond promptly and that the highest quality of patient care is delivered while patients are away from the nursing unit.

Exploring the compassionate care connection.

Although the word "compassion" is an integral component of nursing care, a clear conceptualization of the term is lacking. This article examines compassion from historical, biblical, and global perspectives; spiritual connections; and calls for research to help build our understanding of what compassion means and how to enter into other's suffering.

Scope creep: when nursing practice moves beyond traditional boundaries: an evidence-based example using procedural sedation.

The finite boundaries of the scope of nursing practice are constantly changing. One could expect that with new technology and advances in science, the interventions and assessments nurses perform will change over time. The practice of nursing is governed by nursing, however, it is often challenged by our partners in medicine, and frequently driven by time constraints or reimbursement issues. This article reviews a case example in which nurses were asked to expand their practice to assume responsibility for duties that were once traditionally performed by physicians. An evaluation of a practice problem using an evidence-based approach applying the PICO (population, intervention, comparison, outcome) method is explored. Proposed steps to minimize risk and staff moral distress are also described.