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Transcript of Professional Practicum
Financial and Clinical Benefits
Impact on Patients Professional Practicum Emergency Department Nursing:
Interventions to Reduce Overcrowding By: Stephanie Hanko, Carolyn Olmsted,
& Kyle Kelting Saw many patients with non-urgent needs presenting to ED
Limited staff & number of beds available
Long patient wait times
Decreased patient satisfaction
Increased number of patients leaving AMA and multiple patient's left without being seen
Discharging patient without a PCP
Lack of insurance Our Observations: Patient Flow in ED
Via ambulance, car, walking, helicopter, ambucab Triage RN performs a triage assessment RN Performs assessment, EKG obtained by nurse tech PRN, seen by NP, PA or MD (depending on acuity). Assigned Room Inpatient
Discharged Patient Arrives tri·age
noun \trē-äzh, trē-\
Definition of TRIAGE
1 : the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors
2 : the sorting of patients (as in an emergency room) according to the urgency of their need for care Assigned Acuity level 1-5 Labs drawn, diagnostics peformed Low acuity: fast track
High acuity: assigned room Waiting
Medication & treatments provided What causes overcrowding?
What are the effects of overcrowding on nurses, healthcare team members, and patients?
What are strategies to reduce overcrowding? Identification of the Problem History of the Problem Over the past decades, ED overcrowding has caused major challenges to providing emergency health care. In response, ED's have developed new models of delivery to fit the demands of crowded ER's (McClelland et al, 2011, p. 1392).
Yet, the number of hospital ED’s decreased by 10% during this same time frame (Wiler et al, 2010, p. 142).
The AHA reports that 69% of urban hospital ED’s and 33% of rural hospital ED’s are operating at or over capacity ((Wiler et al, 2010, p. 142).
Many improvements are "ad hoc" in character, thus research and generalizable outcomes are limited (Oredsson, 2011, p. 1). (CNN, 2010) Application to Nursing Practice In emergency departments, what is the effect of observation units, inpatient holding areas, and fast track systems on overcrowding compared to holding patients in the emergency department and lack of fast track areas. PICO P: Emergency Department patients
I: use of observation or holding units and fast track areas
C: Holding admitted patients in the Emergency Department and lack of fast track areas
O: decreased overcrowding in emergency departments Why Have ED Fast Track Areas? Purpose
What changes are necessary?
Type of patients in holding area
Cost vs. profit
Low census Increased workload Burnout and higher ED unit turnover rates Stress Less time available for higher acuity patients Lack of space and beds for patients (hall beds) Increased time spent discharging Decreased lengths of stay Reduction in Wait Times Decreased Costs Increased Patient Satisfaction Staff Availability to See higher acuity patients Observation Units History
Financial and Clinical Benefits
Challenges Holding Areas (Ashton, 2012), (Baugh, 2011), (Wiler, Ross, & Ginde, 2011). (Gantt, 2004), (Kolb, Schoening, Peck, & Lee, 2008). 2006 Study in Journal of Emergency Medicine In spite of a 4.43% increase in the daily census, FTA opening was able to reduce both WT and LOS for the total patient population by 50% and 9.79%, respectively.
Done without a change in mortality rates or revisits!
Increased ED effectiveness without a deterioration in QOC provided These findings show... Decreasing
ED Crowding Fast Track Observation Units Holding Areas Butterworth's ED Implementation of a "Flex" area 2 consult rooms designated for triage and fast track 6 Modules for patient care, organized by acuity ED Holding area: 9 center Chest pain Center and Chest pain observation in addition to general observation From 1995 through 2005, the annual number of ED visits in the United States increased nearly 20%, from 96.5 million to 115.3 million Frustration Opens and closes depending on how much overcrowding ER is experiencing at a given time...flexible! 4 Flex Rooms with assigned RN/NP/PA care providers Lower acuity patient’s can be assessed, treated, and discharged at an accelerated pace What interventions can the nurse perform to decrease overcrowding? Conclusions Fast track
Observation Be non-judgemental. Insurance? Convenient? Warm place? Drug seeking? We don't know..... Emergency Medicine is Complex Macro level Meso level Micro level RRecommendations Research based recommendations: Research Slide: Info on Fast Track Research Slide: info on fast track Research slide: info on obs units Research slide: info on holding areas Research slide: systematic review of ER interventions to reduced overcrowding Research slide: systematic review, interventions to reduce overcrowding What does this mean? Implementing evidence is not always easy.
This is rarely a quick fix that works to solve overcrowding Breakdown of Research