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Effects of Interruptions on Triage Process in Emergency Department: A Prospective, Observational Study


Published on: 10.19.2018
Associated with: October/December 2018, Volume 33, Issue 4;

Incomplete or inaccurate triage examination in an emergency department can result in delays, which could compromise patient outcomes. Dr. Johnson discusses the outcomes of her study on triage interruptions and how they affect the triage process. A significant difference was seen in triage duration between interrupted and uninterrupted interviews. Understanding the impact of interruptions on patient outcomes allows nurses and other health care providers to develop interventions to mitigate the impact.

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Incomplete or inaccurate triage examination in an emergency department can result in delays, which could compromise patient outcomes. Dr. Johnson discusses the outcomes of her study on triage interruptions and how they affect the triage process. A significant difference was seen in triage duration between interrupted and uninterrupted interviews. Understanding the impact of interruptions on patient outcomes allows nurses and other health care providers to develop interventions to mitigate the impact.
Creator:
Duration:
Mr. Yokota and his team investigated the effect of using a fall risk screening tool in an EMR by using data for 25 039 patients in 24 general wards at a large health system in Tokyo. The probability of the occurrence of falls decreased after the tool was implemented, but using the tool did not reduce the actual occurrence of falls. The author summarizes the findings in the video and describes the full study in the article.
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Duration:
Achieving optimal compliance for bar code medication administration (BCMA) in mature medication use systems is challenging due to the iterative system refinements over time. The author describes a nursing leadership initiative to increase BCMA compliance, measured as a composite across all hospital units. Compliance increased from 95% to 98%, but most importantly, through this initiative, leadership discovered unanticipated benefits and unintended consequences. The methodology used provides valuable insight into effective strategies for BCMA optimization with applicability for other QI initiatives. After watching the video, learn more about the initiative in the article.
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Learn more about this study of 1933 RNs in 24 hospitals with shared leadership and the nurses’ perceptions of their decisional involvement. The author explains the study and its implications for nurses. Be sure to read the article for details about this important study and how you can use the findings in your own health care setting.
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Learn about this QI initiative to improve oropharyngeal dysphagia screening and reduce aspiration pneumonia rates on inpatient hospital medical units. Guided by a Plan-Do-Study-Act methodology, an interdisciplinary health team developed and implemented a systematic process for oropharyngeal dysphagia screening and management. As a result, use of the screening protocol increased, timely initiation of speech language pathology consultations increased, and aspiration pneumonia rates decreased. After watching this video, be sure to read the article.
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Duration: 2:33
The purpose of this project was to determine whether patients with COPD receiving in-home visits by a nurse practitioner (NP) in a program called Community Cares had fewer hospital encounters such as ED visits, observation stays, and inpatient admissions. With in-home NP visits, inpatient encounters decreased by 71%; ED visits decreased by 68%; and there was an 84% reduction in 30-day readmissions. Learn more about this program (from a patient and NPs). Don’t miss this video and then read the article.
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Duration: 3:54
Two major cost concerns related to joint replacement surgery are patient length of stay (LOS) and 30-day hospital readmission rates. Dr Ashcraft describes a QI project to evaluate the impact of a joint replacement program on patient readmissions and hospital LOS. A total of 1425 patients older than 50 years participated. At the end of the project period, readmission rates decreased from 6.19% to 2.8%, and average LOS decreased from 5.87 days to 2.7 days. After watching the video be sure to read the article. The authors share strategies for adopting this program in your own setting.
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Duration: 2:49
This study explored the trajectory of patients who remained on a general unit after medical emergency team activation. Of those who had a second activation within 24 hours, 80% occurred within 12 hours of the baseline activation. Chest pain and recent ICU discharge were associated with having a second activation. The authors share their study and discuss implications of interest to nurses across settings. Watch the video and be sure to read the full article.
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Duration: 2:55
The demand for acute care clinical sites, along with the need to prepare CNLs for a role in health promotion, disease prevention, and population health management, created an opportunity for these authors to expand the CNL role outside of the acute care setting. The goal was to allow CNL students to develop competencies in improving patient and population health. Learn how they developed and implemented the course: after watching the video, read the full article. Be sure to access the supplemental content on strategies for clinical site development for CNL in primary care.
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Duration: 4:14
As part of an outcome improvement initiative in an intermediate ICU at the Health Sciences Centre, Winnipeg, Manitoba, Canada, patients participated in an innovation on the effects of collaborative goal setting and activity tracking through a visual display of the goals achieved. Patients had a high degree of engagement in setting their goals. Displaying patients’ progress had an effect on their quality of life and self-efficacy. Learn more about this project in the video and article: this is a project you can easily implement in your settings, and the authors explain how to do it.
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Duration: 3:11
Patient safety checklists are ubiquitous in health care. Nurses bear significant responsibility for ensuring checklist adherence. To report nonadherence to a checklist and stop an unsafe procedure, a workplace climate of psychological safety is needed. The author analyzed organizational data to examine the relationship between psychological safety and reports of nonadherence to the central line bundle checklist. Results showed varied perceptions of psychological safety but no relationship with nonadherence. You will enjoy watching this innovative video and will learn a lot from it (and be sure to also read the article).
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Duration: 4:31
The Consolidated Framework for Implementation Research guided the formative evaluation of the implementation of a redesigned interprofessional team rounding process. The redesigned process was intended to improve health team communication about hospital discharge. Themes emerging from interviews of patients, nurses, and providers revealed the inherent value and positive characteristics of the new process, but also workflow, team hierarchy, and process challenges to successful implementation. The evaluation identified actionable recommendations for modifying the implementation process. Ms. Bahr summarizes the study in this video but be sure to read the full article in JNCQ.
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Duration: 4:08
Clinical nurse leaders (CNLs) improve care at the microsystem level. Learn about the use of the CNL role in an academic medical center for evaluating pressure ulcer reporting – watch this video and be sure to read the article. The authors used the Plan-Do-Study-Act cycle as the methodology for the study. The CNL assessment of pressure ulcers resulted in a 21% to 50% decrease in the number of hospital-acquired pressure ulcers reported in a 3-month time period. The CNL role has potential for improving the validity and reliability of pressure ulcer reporting.
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Duration: 3:53
Approximately a quarter of medication errors in the hospital occur at the administration phase, which is solely under the purview of the bedside nurse. Dr. Gail Armstrong reports on her study that assessed bedside nurses' perceived skills and attitudes about updated safety concepts and examined their impact on medication administration errors and adherence to safe medication administration practices. Findings supported the premise that medication administration errors result from an interplay among system-, unit-, and nurse-level factors. Watch this video and then read Dr. Armstrong’s articles about the study and tool development.
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Duration: 4:40
The QSEN RN-BSN Task Force developed recommendation for a systems-based practice competency. Recommendations are to integrate systems-based practice into both education and practice settings. Watch the video and read the article to learn more about this proposed QSEN competency.
Creator:
Duration: 4:11
Learn more about this study to test an intervention to reduce medication omissions without documentation. The authors are using nurse-initiated recall cards and medication chart checking at handover. Watch the video and then read the full article.
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Duration: 2:10
Most health care quality improvement (QI) studies focus on the engagement of executive leadership and frontline staff as key factors for success. Little work has been done on understanding how mid-level unit/program managers perceive their role in QI and how capacity could be built at this level to increase success. In this video and article, the authors present an ethnographic study on the experience of hospital middle managers to consider how the expectations and capacity of their current position might influence QI progress organizationally.
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Duration: 5:57
Telemetry monitoring is a limited resource. This quality improvement project describes a nurse managed telemetry discontinuation protocol to stop telemetry monitoring when it is no longer indicated. After implementing the protocol, data were collected for 6 months and compared to preintervention. There was a mean decrease in telemetry monitor usage and likelihood of remaining on a telemetry monitor until discharge. Learn about this nurse-managed telemetry discontinuation protocol – watch the video and then read the article.
Creator:
Duration: 3:41
Learn about this project to develop and implement a nurse-driven protocol to remove urinary catheters using evidence-based criteria. The specific aim was to decrease average catheter dwell time with the use of a nurse-driven protocol in MICU patients. In this video the author explains the need for the practice change and how she improved care on the unit. After watching the video, be sure to read the article.



Creator:
Duration:
Incomplete or inaccurate triage examination in an emergency department can result in delays, which could compromise patient outcomes. Dr. Johnson discusses the outcomes of her study on triage interruptions and how they affect the triage process. A significant difference was seen in triage duration between interrupted and uninterrupted interviews. Understanding the impact of interruptions on patient outcomes allows nurses and other health care providers to develop interventions to mitigate the impact.
Creator:
Duration:
Mr. Yokota and his team investigated the effect of using a fall risk screening tool in an EMR by using data for 25 039 patients in 24 general wards at a large health system in Tokyo. The probability of the occurrence of falls decreased after the tool was implemented, but using the tool did not reduce the actual occurrence of falls. The author summarizes the findings in the video and describes the full study in the article.
Creator:
Duration:
Achieving optimal compliance for bar code medication administration (BCMA) in mature medication use systems is challenging due to the iterative system refinements over time. The author describes a nursing leadership initiative to increase BCMA compliance, measured as a composite across all hospital units. Compliance increased from 95% to 98%, but most importantly, through this initiative, leadership discovered unanticipated benefits and unintended consequences. The methodology used provides valuable insight into effective strategies for BCMA optimization with applicability for other QI initiatives. After watching the video, learn more about the initiative in the article.
Creator:
Duration:
Learn more about this study of 1933 RNs in 24 hospitals with shared leadership and the nurses’ perceptions of their decisional involvement. The author explains the study and its implications for nurses. Be sure to read the article for details about this important study and how you can use the findings in your own health care setting.
Creator:
Duration:
Learn about this QI initiative to improve oropharyngeal dysphagia screening and reduce aspiration pneumonia rates on inpatient hospital medical units. Guided by a Plan-Do-Study-Act methodology, an interdisciplinary health team developed and implemented a systematic process for oropharyngeal dysphagia screening and management. As a result, use of the screening protocol increased, timely initiation of speech language pathology consultations increased, and aspiration pneumonia rates decreased. After watching this video, be sure to read the article.
Creator:
Duration: 2:33
The purpose of this project was to determine whether patients with COPD receiving in-home visits by a nurse practitioner (NP) in a program called Community Cares had fewer hospital encounters such as ED visits, observation stays, and inpatient admissions. With in-home NP visits, inpatient encounters decreased by 71%; ED visits decreased by 68%; and there was an 84% reduction in 30-day readmissions. Learn more about this program (from a patient and NPs). Don’t miss this video and then read the article.
Creator:
Duration: 4:14
As part of an outcome improvement initiative in an intermediate ICU at the Health Sciences Centre, Winnipeg, Manitoba, Canada, patients participated in an innovation on the effects of collaborative goal setting and activity tracking through a visual display of the goals achieved. Patients had a high degree of engagement in setting their goals. Displaying patients’ progress had an effect on their quality of life and self-efficacy. Learn more about this project in the video and article: this is a project you can easily implement in your settings, and the authors explain how to do it.
Creator:
Duration: 3:11
Patient safety checklists are ubiquitous in health care. Nurses bear significant responsibility for ensuring checklist adherence. To report nonadherence to a checklist and stop an unsafe procedure, a workplace climate of psychological safety is needed. The author analyzed organizational data to examine the relationship between psychological safety and reports of nonadherence to the central line bundle checklist. Results showed varied perceptions of psychological safety but no relationship with nonadherence. You will enjoy watching this innovative video and will learn a lot from it (and be sure to also read the article).
Creator:
Duration: 4:08
Clinical nurse leaders (CNLs) improve care at the microsystem level. Learn about the use of the CNL role in an academic medical center for evaluating pressure ulcer reporting – watch this video and be sure to read the article. The authors used the Plan-Do-Study-Act cycle as the methodology for the study. The CNL assessment of pressure ulcers resulted in a 21% to 50% decrease in the number of hospital-acquired pressure ulcers reported in a 3-month time period. The CNL role has potential for improving the validity and reliability of pressure ulcer reporting.
Creator:
Duration: 3:53
Approximately a quarter of medication errors in the hospital occur at the administration phase, which is solely under the purview of the bedside nurse. Dr. Gail Armstrong reports on her study that assessed bedside nurses' perceived skills and attitudes about updated safety concepts and examined their impact on medication administration errors and adherence to safe medication administration practices. Findings supported the premise that medication administration errors result from an interplay among system-, unit-, and nurse-level factors. Watch this video and then read Dr. Armstrong’s articles about the study and tool development.
Creator:
Duration: 4:40
The QSEN RN-BSN Task Force developed recommendation for a systems-based practice competency. Recommendations are to integrate systems-based practice into both education and practice settings. Watch the video and read the article to learn more about this proposed QSEN competency.
Creator:
Duration: 4:11
Learn more about this study to test an intervention to reduce medication omissions without documentation. The authors are using nurse-initiated recall cards and medication chart checking at handover. Watch the video and then read the full article.
Creator:
Duration: 5:57
Telemetry monitoring is a limited resource. This quality improvement project describes a nurse managed telemetry discontinuation protocol to stop telemetry monitoring when it is no longer indicated. After implementing the protocol, data were collected for 6 months and compared to preintervention. There was a mean decrease in telemetry monitor usage and likelihood of remaining on a telemetry monitor until discharge. Learn about this nurse-managed telemetry discontinuation protocol – watch the video and then read the article.
Creator:
Duration: 3:41
Learn about this project to develop and implement a nurse-driven protocol to remove urinary catheters using evidence-based criteria. The specific aim was to decrease average catheter dwell time with the use of a nurse-driven protocol in MICU patients. In this video the author explains the need for the practice change and how she improved care on the unit. After watching the video, be sure to read the article.
Creator:
Duration: 7:53
Assessing high risk for falling among psychiatric inpatients is particularly challenging in that assessments with strong sensitivity and specificity are not available. The author explains their study to validate use of the Baptist Health High Risk Falls Assessment (BHHRFA), a medical-surgical fall risk assessment, with a psychiatric inpatient population. Data collected on 5910 psychiatric inpatients using the BHHRFA showed acceptable sensitivity, specificity, and diagnostic odds ratio. After you watch the video, take time to read the article.
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Duration: 3:15
Many readers are interested in transitional care. This video and article provide the information you need. The authors describe their project to reduce readmissions through the establishment of a pilot program using the C-TraC program, which is a phone-based, protocol-driven, low-cost, nurse-led, transitional care model. The goal was to connect with the patients telephonically up to 30 days postdischarge to mitigate current confusion regarding the discharge plan and identify potential medication discrepancies. Learn about this effective transitional care model.
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Duration: 2:41
Medication errors are a source of serious patient harm. A unique approach, Socio-Technical Probabilistic Risk Assessment, was used to analyze medication errors in this pediatric setting. Three steps were identified that should be taken with every intravenous medication or fluid administration. Nurses check for the 3Cs: Connections, Clamps, and Confirming pump settings. Preliminary analysis revealed a 22% reduction in errors. This video is prepared with a pediatric theme!
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Duration: 2:58
Rapid response team (RRT) adoption and implementation are associated with improved quality of care of patients who experience an unanticipated medical emergency. The sustainability of RRTs is vital to achieve long-term benefits of these teams for patients, staff, and hospitals. The author describes a study that examined the relationship between sustainability elements and RRT sustainability in hospitals with RRTs. Watch the video and be sure to read the article.
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Duration: 7:26
Recent changes in the Surgical Care Improvement Project guideline require blood glucose values be less than 180 mg/dL 18 to 24 hours after anesthesia end time after cardiac surgery. The authors studied 2 groups of patients: the first group of patients was transitioned off IV insulin on postoperative day 1, 24 hours after anesthesia end time, whereas the second group was transitioned off IV insulin on the second day, 48 hours after anesthesia end time. The results showed no statistical differences in outcomes between groups. Watch this video and read the article to learn about the study and evidence they gathered from it.
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Duration: 6:12
Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. The author implemented a QI program that integrated early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications. Pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced. Watch this video and read the entire article for free: the article is open access so readers can learn about this important QI initiative.
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Duration: 16:32
A multicomponent intervention was attempted in a pediatric emergency department to increase reporting of workplace aggression committed by patients and visitors. Overall reporting decreased from 53% to 47% (p = .06). Reasons for reporting were severity of incident and being asked to report. However, many incidents were not reported. Watch the video and be sure to read the article.
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Duration: 3:18
Dr. Rahn examined the relationships between nursing teamwork and NDNQI outcomes including pressure ulcers, falls, and catheter-associated urinary tract infections, and she found some significant relationships. Improving teamwork in medical-surgical acute care units can transform care and impact the occurrence of preventable adverse outcomes. Watch this video and read the article to understand the importance of teamwork on your unit.
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Duration: 7:29
The authors examined whether an integrated nursing handover system (structured content and an electronic tool within the patient clinical information system with bedside delivery) would improve the quality of information delivered at nursing handover and reduce adverse patient outcomes. They demonstrated improvements in the transfer of critical patient information and reductions in nursing clinical management incidents. Watch this video and read the article to learn more about this important project.
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Duration: 7:42
Ensuring optimal care coordination requires a clear understanding of how clinician activities and continuity during transitions affect patient-centered care and quality outcomes. Dr. Radwin describes an expanded theoretical framework to better understand care coordination. She provides a clear explanation of concepts. Watch the video and read her article to understand the framework and how you can use it to guide care coordination in your own setting.
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Duration: 7:21
The Race is led by Clinical Nurse Specialists in partnership with nurse leaders to engage frontline staff in QI. Staff adopts evidence-based practice changes and actively engages in friendly competition to improve selected quality metrics. Data from compliance audits and automated outcome metric reports are used to identify top performing units. The Race project provides a focus for frontline staff by helping to correlate the impact on outcomes of providing quality patient care through best practices. The authors explain the project in this video and their article.
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The authors examined the differences between medical-surgical patients who had a Rapid Response Team Intervention (RRTI) and those who did not. There were 5 significant differences between these 2 groups of patients. Watch this video and read the article to learn more about the effectiveness of the Rapid Response Team in this hospital.
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Duration: 5:48
Many fall prevention strategies exist with some degree of effectiveness. Watch this video and read the article to learn about a staff-driven QI initiative to develop a video in partnership with patients and families to prevent falls when hospitalized. Since the video's release, the fall rate has decreased by 29.4%.
Creator: Eileen Lake
Duration: 4:54
Dr. Lake and colleagues describe their study on the associations between the NICU work environment, quality of care, safety, and patient outcomes. A secondary analysis was conducted of responses of 1247 NICU staff nurses in 171 hospitals to a large nurse survey. Better work environments were associated with lower odds of nurses reporting poor quality, safety, and outcomes. Improving the work environment may be a promising strategy to achieve safer settings for at-risk newborns.
Creator: Diane Holland
Duration: 10:35
Are you worried about discharge delays in your institution? If so watch this video to learn how the authors developed and evaluated a mechanism for real-time tracking of discharge delays by bedside clinicians. They also developed a process for reporting delays so actions could be taken. Discharge delay times totaled 23.6 days for 114 patients affected by a delay. More than one-half of the delays (61.4%) were for patients whose discharge disposition was home.
Creator: Mark McClelland
Duration: 7:36
Understanding hospital culture is important to effectively manage patient flow. Dr. McClelland describes a survey he developed to assess a hospital's culture related to in-hospital transitions in care. Eight transition themes were identified using a multidisciplinary team of experts from 3 health care systems. Learn more about this study and the instrument from Dr. McClelland.
Creator: Erica Lewis
Duration: 4:51
Registered nurse (RN) “second victims” are RNs who are harmed from their involvement in medical errors. This study found a relationship between RN involvement in preventable adverse events and 2 domains of burnout: emotional exhaustion (P = .009) and depersonalization (P = .030). Support to RNs involved in preventable adverse events was inversely related to RN emotional exhaustion (P < .001) and depersonalization (P = .003) and positively related to personal accomplishment (P = .002).
Creator: Jan Bahle
Duration: 3:12
The goal of an At Risk Care Plan is to improve safety and quality care by proactively anticipating individual needs of patients at risk and to communicate those to the health care team. This innovative intervention has dramatically reduced hospital readmissions, costs, and adverse events for high-risk adult inpatients in a small community hospital.
Creator: Danielle Miller
Duration: 7:54
A follow-up telephone call within 72 hours of discharge reduced the readmission rate. Learn how to do this in your own setting.
Creator: Paula Restrepo
Duration: 2:52
Deep vein thrombosis (DVT) remains a source of adverse outcomes in surgical patients. Nurses created a guideline for using non-invasive mechanical modalities for prophylaxis. Read more about this project.
Creator: Meredith Borak
Duration: 5:35
Early defibrillation is critical for patients with in-hospital cardiac arrest. This video and article describe how a team at The University of Chicago Medicine increased the rate of early defibrillation by nurse first responders in noncritical care areas.
Creator: Michelle Kimrey
Duration: 4:04
Learn how this team used team training to reduce falls. The intervention group improved on all measures except teamwork perception. A 60% fall reduction rate was reported in the intervention group. Read more about this study.