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Congress2017 poster winners

Hampton, Michelle M., PhD, RN, NEA-BC; Harfield, Charolette, MSN, RN, NEA-BC; Maurer-Swan, Ellen L., BSN, RN, CNML

doi: 10.1097/01.NUMA.0000544461.66204.77
Feature

The following articles represent the first-place and runner-up winners from the NMCongress2017 poster contest. Both posters were presented and recognized at last year's conference. Congratulations to our winners!

Presenting the first-place and runner-up winners from the Nursing Management Congress2017 poster contest. Both posters were recognized at last year's conference.

At Texas Health Harris Methodist Fort Worth (Tex.), Michelle M. Hampton is the director of nursing operations and Charolette Harfield is the manager for the resource team/patient advocate department/dismissal lounge.

Ellen L. Maurer-Swan is a nurse manager at Kenmore Mercy Hospital in Buffalo, N.Y.

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1ST PLACE Implementation of a hospital dismissal lounge to improve patient flow

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Many US hospitals operate at capacity, and many patients are boarded in the ED because of a lack of inpatient beds.1 Few interventions have been shown to successfully improve patient flow. A 720-bed tertiary care center with greater than 100% effective occupancy and over 120,000 ED visits per year implemented a hospital-based dismissal lounge to positively impact patient flow through the busy ED.

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Strategy and implementation

On-time discharges are a significant factor in maintaining optimal patient flow. There are several factors that impact delays in patient discharge, including delays in testing, delays in receipt of discharge order, inability of the nurse to prioritize discharge, and transportation issues.2 These delays inadvertently lead to ED overcrowding and increases in ED boarding times. A group of nurse leaders met to analyze barriers to patient flow and proposed a cost-effective way to improve patient flow with the implementation of a hospital dismissal lounge. The lounge began as a pilot project and has quickly transformed into a fully functioning unit within the hospital.

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The dismissal lounge is centrally located within the hospital and can accommodate up to 10 discharged patients at a time. The lounge is equipped with recliners, two large TVs, and welcoming decor. It's fully staffed for 9 hours, with a minimum of 3 RNs, 1 patient care technician, and 1 patient transporter. Although the RN isn't providing routine care, nursing staff can administer some medications needed before discharge, such as insulin, vaccines, and last doses of I.V. antibiotics, while patients are in the lounge. The RN provides thorough discharge instructions and reiterates important patient education. Alert, ambulatory, continent patients who are discharged to home are identified as appropriate for the lounge.

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Evaluation

The dismissal lounge started seeing patients on November 9, 2015. Since it's been operational, 9,115 patients have been discharged home through the dismissal lounge. This represents approximately 10% of the daily hospital discharges. On average, the dismissal lounge discharges 20 to 25 patients per day. In 2018, it's discharged an average of 400 patients per month. A majority of the patients are medical/surgical/telemetry in nature; however, the lounge assists with procedural areas and ED discharges when needed.

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Discussion

When evaluating the data to support the opening of the dismissal lounge, discharges home were taking approximately 5 to 6 hours. Currently, discharges are taking half that time. This enhances hospital flow and has decreased the number of boarded patients in the ED and hold times.

An additional benefit of the dismissal lounge has been a decrease in readmission rates. When comparing readmission rates for patients discharging from an inpatient unit with those of patients discharged through the dismissal lounge, the readmission rates for patients discharged home through the dismissal lounge are lower. It's hypothesized that this reduction in readmission rates may be the result of fewer distractions in the dismissal lounge and the ability for the discharging nurse to do a comprehensive review of the patient's discharge instructions, which includes reviewing follow-up care and medications. Additional research is needed to investigate this claim.

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Conclusions

The dismissal lounge census continues to increase. In 1 week more than 116 patients were discharged through the lounge. Through June 2018, 47% of patients have been discharged within 2 hours of receiving a discharge order and 42% have been discharged before 2 p.m. The dismissal lounge has enhanced patient flow by freeing up needed patient beds for boarded patients in the ED.

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REFERENCES

1. American College of Emergency Physicians. To reduce emergency department boarding and hospital crowding, look beyond the ED. 2016. http://www.acepnow.com/article/reduce-emergency-department-boarding-hospital-crowding-look-beyond-ed.

2. Majeed MU, Williams DT, Pollock R, et al Delay in discharge and its impact on unnecessary hospital bed occupancy. BMC Health Serv Res. 2012;12:410.

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RUNNER-UP Safe patient handling with a “move with care” program

One of five acute care hospitals that make up Catholic Health in Buffalo, N.Y., Kenmore Mercy Hospital is a Magnet®-recognized hospital licensed for 184 beds. The hospital's goal is to provide safe patient handling with a reduction of associate injury and a decrease in lost work days related to patient handling. The Occupational Safety and Health Administration reportable data indicated a need to reduce associate injury.

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Design

Catholic Health partnered with a national consulting company to provide an innovative clinical approach for developing a safe patient transfer program to reduce associate injury. The vice president of patient care services and CNO identified a nurse manager to be the Kenmore Mercy Hospital champion for the “move with care” initiative. A project mapping meeting was held on March 13, 2015, involving key interprofessional stakeholders to devise a plan to effectively implement the initiative.

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Implementation

Each department identified “master movers” who were selected and trained to be a resource in their departments. They've been effective in identifying supplies, equipment, and environmental and additional education needs. “Master movers” received 8 hours of education, with two additional 2-hour sessions of training. All other clinical associates completed a 2-hour class, including hands-on training.

The startup on July 28, 2015, was celebrated with an ice cream kickoff for all shifts. Clinical consultants were present for the initiation of the program to ensure proper usage of equipment and safe patient handling, and to answer any questions.

Clinical consultants visit monthly to ensure the sustained success of the program by acting as a resource. In addition, they offer training to new associates, refresher opportunities for existing associates, and round on clinical areas to provide opportunities for hands-on demonstrations and answering questions.

A safe patient handling committee meeting is held every other month, cochaired by the health and safety manager and an RN. Other members include the nurse manager/“move with care” champion, unlicensed assistive personnel, a radiology transport team member, radiology technicians, and a physical therapist. In addition to reviewing opportunities for improvement, accomplishments are reported and goals set for the upcoming year. A quarterly meeting for the “master movers” was also implemented.

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In 2016, to reinforce the positive outcomes of the program during the first year, all associates and visitors were invited to a cupcake celebration.

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Equipment selection

The selection of the “move with care” equipment for each individual patient is determined by the nurse completing the “move with care” assessment in the electronic medical record.

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Outcomes and results

Data analysis was performed pre- and postimplementation of the “move with care” program. As a result of the program, Kenmore Mercy Hospital has been able to demonstrate a decrease in associate injury, with a significant decrease in lost work days following implementation.

Beginning in 2017, New York state law mandated associate competencies for safe patient handling. Due to the implementation of the “move with care” program, Kenmore Mercy Hospital was well-prepared to be compliant with the new law.

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Implications for practice

The interprofessional approach to education and training was successful in yielding a significant decrease in associate injury and 0 lost work days in the last 12 months. Therefore, a “move with care” program would be beneficial to any healthcare facility or homecare setting.

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RESOURCES

Biviano M, Spencer W, Fritz MS. What is behind HRSA's projected supply, demand, and shortage of registered nurses? 2004. http://www.ohiocenterfornursing.org/PDFS/nursingworkforceHRSAbehindshortage.pdf.

Haney LL, Wright L. Sustaining staff nurse support for a patient care ergonomics program in critical care. Crit Care Nurs Clin North Am. 2007;19(2):197–204.

Waters TR. When is it safe to manually lift a patient. Am J Nurs. 2007;107(8):53–58.

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