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Improving Throughput for Patients Admitted from the Emergency Department: Implementation of a Standardized Report Process

Video Author: Wolak, Eric DNP, RN, NEA-BC; Jones, Cheryl PhD, RN, FAAN; Leeman, Jennifer DrPH; Madigan, Catherine DNP, RN, NEA-BC
Published on: 10.02.2020
Associated with: Journal of Nursing Care Quality. 35(4):380-385, October/December 2020

Inefficient emergency department to inpatient handoff processes can contribute to delayed care. Lean methodology was used to evaluate flow and identify opportunities for improvement. Two tools were developed to standardize handoff. Emergency department length of stay and admission wait times were not significantly improved following intervention implementation. However, patient transfer time decreased significantly from 30.5 to 21.7 minutes. The length of time to give/receive report also decreased. Watch the video and then follow up by reading the article.

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Creator: Allen, Alicia MSN, RN, BC; Frederick, Logan MS, RHIA; Hovey, Susan L. PhD, RN
Duration: 3:18
A community hospital recognized patients with multiple chronic conditions had higher rates of inpatient stays and emergency department visits. Patients with multiple chronic conditions enrolled in a supportive care program. Palliative care nurses were assigned to patients enrolled in the program. There was a significant decrease in hospital utilization and inpatient stays following the implementation of the supportive care program. Learn more about this program and how to implement it in your own setting by watching the video and be sure to read the article.
Creator: Tschannen, Dana PhD, RN; Alexander, Catherine DNP, MPH, RN; Tovar, Elizabeth G. PhD, APRN; Ghosh, Bidisha MS; Zellefrow, Cindy DNP, MSEd, RN, LSN, PHNA-BC, EBP-C; Milner, Kerry A. DNSc, RN
Duration: 4:35
Frontline nurse engagement in quality improvement (QI) improves nurse-sensitive outcomes. The purpose of this study was to develop and psychometrically evaluate the Nursing Quality Improvement in Practice (N-QuIP) tool to measure nurses' competency, engagement, and barriers/facilitators to QI engagement. Item development was guided by an expert panel and literature review. Factor analysis and reliability indices were assessed through 681 surveys completed by nurses at one medical center. Preliminary data suggest that the N-QuIP is a valid and reliable tool for assessing nurse QI competence and engagement. Watch the video and read the article.
Creator: Gonzalez, Yovan DNP, RN, FNP-BC; Kozachik, Sharon L. PhD, RN, FAAN; Finnell, Deborah S. DNS, RN, CARN-AP, FAAN
Duration: 3:20
Screening, brief intervention, and referral to treatment (SBIRT) for substance use has an impact on morbidity and mortality and on health care cost. In this project, nurses in ambulatory care completed an online self-paced program focusing on alcohol and drug use screening, motivational interviewing, and referral to specialty treatment. Postintervention knowledge scores increased. Facilitator and barrier themes included time, education, resources, receptivity, and interprofessional collaboration. The SBIRT online program was feasible for nurses to complete during work hours and resulted in increased SBIRT-related knowledge.
Creator: Vessey, Judith A. PhD, MBA, RN, FAAN; Williams, Lucinda DNP, RN, PNP, NE-BC
Duration: 6:36
Bullying and lateral violence are pervasive in the nursing workforce and have profound consequences for nurses, their patients, and the overall health care organization. An iterative, multimodal QI initiative was crafted on the basis of the evidence and principles of transformational, adult learning. Six units were designed to foster learning specific to bullying and lateral violence and their prevention. Each unit consisted of formal lecture content, practice exercises, and reflection. This initiative is appropriate for adoption by other nursing units.
Creator: Wolak, Eric DNP, RN, NEA-BC; Jones, Cheryl PhD, RN, FAAN; Leeman, Jennifer DrPH; Madigan, Catherine DNP, RN, NEA-BC
Duration: 3:02
Inefficient emergency department to inpatient handoff processes can contribute to delayed care. Lean methodology was used to evaluate flow and identify opportunities for improvement. Two tools were developed to standardize handoff. Emergency department length of stay and admission wait times were not significantly improved following intervention implementation. However, patient transfer time decreased significantly from 30.5 to 21.7 minutes. The length of time to give/receive report also decreased. Watch the video and then follow up by reading the article.
Creator: Johnson, Hannah DPT, PT, GCS
Duration: 3:02
Six Sigma was used in a nursing home to improve the functional maintenance program charting/auditing. With the existing staff, capability was increased by 17 residents ($200 000 revenue) and 90% to 100% charting congruence was achieved. Learn more about implementing QI in nursing homes in this video and article.
Creator: Dermody, Gordana PhD, RN, CNL; Odom-Maryon, Tamara PhD; Zimmerman, Jennifer BSN, RN; Glass, Courtney BSc, MDiet
Duration: 3:53
Physical inactivity during hospitalization commonly results in functional decline. The purpose of this study was to determine whether a volunteer-assisted mobility program was feasible to improve the ambulation of hospitalized patients. Hospitalized patients (N = 490) were approached, with 39.2% (n = 192) agreeing to ambulate an average of 109.7 m. The findings suggest that a volunteer-assisted interdisciplinary program is a feasible way to promote the ambulation of some patients. The lead author explains the study in this video, then read the article for more details and how you can implement this in your own setting.
Creator: Soncrant, Christina MPH; Neily, Julia RN, MS, MPH; Bulat, Tatjana MD, CMD; Mills, Peter D. PhD, MS
Duration: 8:08
Injurious falls continue to challenge health care. Learn about this study that analyzed root cause analysis reports on falls and coded injury type, fall type, location, and root causes. There were 154 reported fall RCAs during the study period. Most (83%, n = 128) falls resulted in major injury: hip fractures (43%, n = 66), other fractures (25%, n = 38), and head injury (16%, n = 24). Most falls were unwitnessed (75%, n = 116). Patients who fell were not wearing hip or head protection. These interventions may help prevent future injurious falls. After you watch this informative video, read the full article.
Creator: McClain, Jesse V. IV DNP, APRN, ACNS-BC, CCRN, MSCN, SCRN; Chance, Elisha A. BSAS, CCRC
Duration: 2:45
An advanced practice registered nurse (APRN) led a transitional care clinic for stroke survivors. The goal was to improve transitions from hospital to home. Patients seen in the clinic had a lower 30-day readmission rate (1.5%) compared to non clinic patients (13.4%), p = .003). The 90-day readmission proportion was also higher in nonclinic patients (12.8%) vs those seen in the clinic (4.4%), p = .058. The results suggest the APRN-led clinic may impact hospital readmissions in stroke/transient ischemic attack survivors.
Creator: Hagle, Mary PhD, RN-BC, FAAN; Dwyer, Darcy DNP, RN, ACNS-BC; Gettrust, Lynn DNP, RN, ACNS-BC; Lusk, Dana DNP, RN, CHPN, AHN-BC; Peterson, Kristen BSN, RN; Tennies, Sherry MSN-Ed, RN-BC, CWOCN
Duration: 2:57
The I3 (Inquiry, Improvement, and Innovation) Model was developed to guide EBP and QI projects, research studies, and innovation. The model provides an algorithm with steps and decision points for nurses to follow based on a question from a clinical issue or problem. The model is used for guiding projects in the health care system.
Creator: Loftin, Edwin DNP, RN, NEA-BC, FACHE; Andrews, Diane PhD, RN; Mikitarian, George DHA, FACHE; LaManna, Jacqueline PhD, APRN, ANP-BC, BC-ADM, CDE
Duration: 2:14
The purpose of this QI project was to achieve zero preventable harm to patients during transitions in care from the emergency department to medical/surgical areas. Once the initial design was complete, small tests of change were deployed until zero harm was achieved. This is a replicable project so after watching the video be sure to read the article.
Creator: Oh, Jong Hee MS, RN, CNL, CRNI, VA-BC; Shelly, Mark MD; Nersinger, Sharon MS, RN, NEA-BC; Cai, Xueya PhD; Olsan, Tobie PhD, RN, NEA-BC, CNL, FNAP
Duration: 4:40
A community hospital policy of routinely replacing peripheral intravenous catheters (PIVCs) needed updating to clinically indicated replacement. Guided by Lean principles, a clinical nurse leader led a QI small test of change on a 38-bed medical unit. Nurses managed 469 inpatients, receiving 1033 PIVCs. Routine PIVC replacement declined from 34% to 3% (P < .001). PIVC dwell time ranged from 4 to 20 days and did not increase phlebitis (P = .41) or catheter-related bloodstream infections. Clinically-indicated PIVC replacement reduced unnecessary catheter insertions, maintained patient safety, and improved efficiency. Learn about this project in the video and article.
Creator: Mundle, William RN, MN, CMSN(C); Howell-Belle, Carnett RN, MN; Jeffs, Lianne PhD, RN, FAAN
Duration: 4:10
Catheter-associated urinary tract infections (CAUTIs) rates in our unit were higher when compared with the overall hospital rates. An interprofessional working group developed and implemented a QI bundled approach to reduce CAUTIs. There was a 79% reduction in average CAUTI rates following the bundle implementation along with reduced variability in rates.
Creator: Hart, Danielle RN (EC); Hopman, Wilma M. MA; Hammond, Sharlene BN, RN; Redfearn, Damian P.
Duration: 3:12
Atrial fibrillation (AF) care can be episodic and heavily reliant on hospital resources, particularly the emergency department (ED). A nurse practitioner developed a new program to improve AF care after an ED visit, which included contacting patients by telephone. Telephone contact was highly effective: 37 of 90 patients with AF presented to the ED prior to telephone contact and 7 of 90 patients did so post–telephone contact (P < .001). Telephone practice led by an NP provides an opportunity to improve assessment and management of patient care. Learn more about this intervention in this video and read the full article.
Creator: McNeill, Margaret M. PhD, RN, APRN-CNS, CCRN-K, CCNS, TCRN, CPAN, NE-BC, NHDP-BC, FAAN; Archer, Susan DNP, RN, APRN-CNS, CCRN; Remsburg, Dana MSN, RN, CCRN; Storer, Jill BSN, RN; Rudman, Heather BSN, RN
Duration: 5:07
Using a rapid response team (RRT) and quality champion (QC) nurses at a community hospital provides benefits not entirely captured by analysis of mortality data. The purpose of this study was to determine the perceived benefits of the RRT at our facility and behaviors and activities observed during actual RRT responses. This was a mixed-method study including qualitative (interviews, focus groups, and surveys) and quantitative (retrospective chart reviews) data collection. Benefits of the RRT-QC registered nurse were extensive. Observations showed support, education, and teamwork in an effort to improve outcomes and support clinicians.
Creator: Smith, Catherine V. DNP, RN, CCNS, CCRN; Maduro, Ralitsa S. PhD; Morgan, Merri K. DNP, RN, CCRN; Ver Schneider, Patricia; Rutledge, Carolyn M. PhD, FNP-BC; Zimbro, Kathie S. PhD, RN
Duration: 5:53
Palliative care (PC) referrals are often underutilized or delayed. To improve referrals, interdisciplinary rounds (IDRs) were implemented on the hospitalist service in a nonintensive care setting. Following implementation, median time to PC referral decreased by 2 days. Length of stay, direct cost, and 30-day mortality also decreased. Postintervention patients were more likely to transition home compared with another facility. Learn about the project in this video and then read the article: You can get CE credits for this article!
Creator: Hedges, Christine, PhD, RN, NE-BC; Hunt, Candice, MHA; Ball, Pamela, BSN, RN, NE-BC
Duration: 2:44
A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for Quiet Time (QT) and used HCAHPS “always quiet” scores as the primary outcome measure. The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels. Quiet scores improved on both units after 11 months. You will appreciate the level of noise patients experience in hospitals (watch this video for a demonstration) and learn more about QT intervention – you can implement QT in your settings. Don’t miss this video and article (and get your Continuing Education).
Creator: Schwartz, Franklin, DNP, APRN, PMHNP-BC; Bjorklund, Pamela, PhD, APRN, PMHNP-BC, CNS-BC
Duration: 3:58
In this video, the author describes a violence management program that she and her coauthor piloted on a general medical unit following staff requests for measures to protect them from patient and visitor violence. An independent pre/posttest design measured changes in participant knowledge. The Staff Observation Assessment Scale Revised (SOAS-R) was used for data collection on aggression pre- and postimplementation. The violence management training program included in situ simulation training in de-escalation techniques. Knowledge of de-escalation techniques to reduce violence risk increased. In the article the authors share important lessons for ongoing program implementation.
Creator: Shoqirat, Noordeen, PhD; Mahasneh, Deema, PhD, MSc, RGN; Dardas, Latefa, PhD, PMHN; Singh, Charleen, PhD, MSc, RGN, Neuro-SN; Khresheh, Reham, PhD
Duration: 1:25
The purpose of this study was to qualitatively analyze nursing documentation of pain management among postoperative patients in Jordan. A documentary analysis method was used. A purposive sample of 80 medical records were reviewed, and a total of 720 nursing records were analyzed. The analysis revealed that nurses' documentation of pain management was limited, vague, incomplete, and largely dependent on their subjective evaluation. There also was little documented evidence of efforts to evaluate the effectiveness of pain management interventions. Dr Shoqirat explains the study in this video, and you can learn more about the study in his article.
Creator: Misto, Kara, PhD, RN; Padula, Cynthia, PhD, RN; Bryand, Elizabeth, BSN, RN-BC; Nadeau, Kate, MPH, RN
Duration: 5:16
While there are many benefits of EMR documentation, the presence of a computer may adversely affect provider-patient interaction. The purpose of this project was to examine staff nurses' perception of the impact of electronic documentation in the presence of the patient on the nurse-patient relationship. A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses. Nurses identified benefits and challenges to EMR documentation and strategies to maintain therapeutic relationships and communication. Dr Misto explains the study in this video and article.