- Email: [email protected]
9. Implementation of a Core Charge Nurse Program in the Emergency Department.
RESEA RCH ABSTRA C TS
8. Implementation of a Full-Capacity Protocol: How Policy and Practice Can Alleviate ED Overcrowding. Mary Jo Stark, RN, BSN, CEN, Cheryl Barraco, RN, MS, Carolyn Santora, RN, MS, Karen Kelly Sproul, RN, MS, CEN, 9 Settlers Way, Setauket, NY 11733, E-mail: [email protected] Purpose: Overcrowding in emergency departments is a nationwide problem. It overextends ED resources, decreases access to emergency care, and decreases patient and staff satisfaction. In July 1999, our emergency department, not immune to these issues, received a Press Ganey Rating in the bottom one percentile for patient satisfaction. In order to improve its patient satisfaction ratings, a continuous quality improvement (CQI) steering committee was assembled at the executive level to address the impact of ED overcrowding on patient satisfaction. This project illustrates how a change in policy and practice can alleviate ED overcrowding and impact patient outcomes. Setting: The CQI project was implemented in a level I trauma center in a large teaching university hospital. Methods: The CQI steering committee spent several months implementing initiatives to improve patient satisfaction, including enforcing compliance with the 11 AM discharge time, developing a discharge team, and identifying patients pending discharge. No success was achieved with these initiatives because inpatient units were not receptive to fixing what they considered an ED problem. To address the problem of delayed inpatient admissions, the hospital administration endorsed implementation of the full-capacity protocol. This protocol states that when the emergency department is no longer able to evaluate and treat patients in a timely fashion, patients awaiting admission will be transferred to acute-care hallway beds on inpatient units. Results: Since the implementation of the full-capacity protocol, patient satisfaction scores have risen to the eightieth percentile of the Press Ganey Rating. ED staff also reported improved job satisfaction. Admitted patients, held in the emergency department, had a decrease in average length of stay from 6.2 days to 5.4 days. Unpublished hospital data revealed that patients assigned to an acute-care hallway bed received bed assignments faster than if they remained in the emergency department. Recommendations: The full-capacity protocol effectively addressed the issue of ED overcrowding and has had positive effects on patient and staff satisfaction. The full-capacity protocol is an effective tool that hospitals can use to meet the Joint Commission on Accreditation of Healthcare Organizations standard on ED overcrowding.
9. Implementation of a Core Charge Nurse Program in the Emergency Department. Charlotte Buckenmyer, RN, BS, MS, CRNI, Cheryl Celia, RN, BSN, Gina Sierzega, BA, MA, Lehigh Valley Hospital and Health Network, Department of Emergency Medicine, 4538 Apple Tree Lane, Bethlehem, PA 18015, E-mail: [email protected] Purpose: Emergency departments nationwide are experiencing an unprecedented influx of patients. It is imperative that ED leadership ensures efficient, effective management. Nurses are responsible for many daily operations of the emergency department and are often held accountable for deciding whether the emergency department should close and divert patients. Therefore, our institution implemented a core charge nurse program in an attempt to decrease diversion times, improve consistency with ED leadership decisionmaking regarding diversion status, and produce trained, skilled nursing leaders while decreasing ED staff turnover. Design: Over a 1-year period, a team of core charge nurses was developed to determine if a core charge nurse program was more effective than the traditional charge nurse position that included all ED nurses. Setting and Subjects: Approximately 26 nurses at a level I trauma center emergency department were invited to participate. Methods: Development of the core charge nurse program by ED nursing management began in autumn 2002 and was implemented in March 2003. All ED nurses were encouraged to participate in development of the core charge nurse role. ED management, in conjunction with 10 registered nurses (RNs), actively participated in role development. A committee met biweekly to establish criteria, roles, and responsibilities for the core charge nurses. Potential candidates were found among individual volunteers and those recommended by physicians and peers. From those recommendations, RNs were chosen to participate in the core charge nurse program. They attended educational workshops that focused on core charge nurse responsibilities and leadership development, including leadership styles, decision making, operation improvement, listening techniques, and confident communication. Results: Twenty-four nurses underwent training and education and assumed the charge nurse role. There was a moderate decrease in diversion hours, in addition to a reduction in staff turnover since inception of the core charge role. Recommendations: The core charge nurse role is highly recommended for emergency departments seeking strong leadership and management of ED communications, staffing, and operations. Further studies are necessary to determine relationships between the core charge nurse group, job satisfaction, diversion hours, and lengths of stay for ED patients.
June 2004
JOURNAL OF EMERGENCY NURSING
30:3
209
8. Implementation of a Full-Capacity Protocol: How Policy and Practice Can Alleviate ED Overcrowding. Mary Jo Stark, RN, BSN, CEN, Cheryl Barraco, RN, MS, Carolyn Santora, RN, MS, Karen Kelly Sproul, RN, MS, CEN, 9 Settlers Way, Setauket, NY 11733, E-mail: [email protected] Purpose: Overcrowding in emergency departments is a nationwide problem. It overextends ED resources, decreases access to emergency care, and decreases patient and staff satisfaction. In July 1999, our emergency department, not immune to these issues, received a Press Ganey Rating in the bottom one percentile for patient satisfaction. In order to improve its patient satisfaction ratings, a continuous quality improvement (CQI) steering committee was assembled at the executive level to address the impact of ED overcrowding on patient satisfaction. This project illustrates how a change in policy and practice can alleviate ED overcrowding and impact patient outcomes. Setting: The CQI project was implemented in a level I trauma center in a large teaching university hospital. Methods: The CQI steering committee spent several months implementing initiatives to improve patient satisfaction, including enforcing compliance with the 11 AM discharge time, developing a discharge team, and identifying patients pending discharge. No success was achieved with these initiatives because inpatient units were not receptive to fixing what they considered an ED problem. To address the problem of delayed inpatient admissions, the hospital administration endorsed implementation of the full-capacity protocol. This protocol states that when the emergency department is no longer able to evaluate and treat patients in a timely fashion, patients awaiting admission will be transferred to acute-care hallway beds on inpatient units. Results: Since the implementation of the full-capacity protocol, patient satisfaction scores have risen to the eightieth percentile of the Press Ganey Rating. ED staff also reported improved job satisfaction. Admitted patients, held in the emergency department, had a decrease in average length of stay from 6.2 days to 5.4 days. Unpublished hospital data revealed that patients assigned to an acute-care hallway bed received bed assignments faster than if they remained in the emergency department. Recommendations: The full-capacity protocol effectively addressed the issue of ED overcrowding and has had positive effects on patient and staff satisfaction. The full-capacity protocol is an effective tool that hospitals can use to meet the Joint Commission on Accreditation of Healthcare Organizations standard on ED overcrowding.
9. Implementation of a Core Charge Nurse Program in the Emergency Department. Charlotte Buckenmyer, RN, BS, MS, CRNI, Cheryl Celia, RN, BSN, Gina Sierzega, BA, MA, Lehigh Valley Hospital and Health Network, Department of Emergency Medicine, 4538 Apple Tree Lane, Bethlehem, PA 18015, E-mail: [email protected] Purpose: Emergency departments nationwide are experiencing an unprecedented influx of patients. It is imperative that ED leadership ensures efficient, effective management. Nurses are responsible for many daily operations of the emergency department and are often held accountable for deciding whether the emergency department should close and divert patients. Therefore, our institution implemented a core charge nurse program in an attempt to decrease diversion times, improve consistency with ED leadership decisionmaking regarding diversion status, and produce trained, skilled nursing leaders while decreasing ED staff turnover. Design: Over a 1-year period, a team of core charge nurses was developed to determine if a core charge nurse program was more effective than the traditional charge nurse position that included all ED nurses. Setting and Subjects: Approximately 26 nurses at a level I trauma center emergency department were invited to participate. Methods: Development of the core charge nurse program by ED nursing management began in autumn 2002 and was implemented in March 2003. All ED nurses were encouraged to participate in development of the core charge nurse role. ED management, in conjunction with 10 registered nurses (RNs), actively participated in role development. A committee met biweekly to establish criteria, roles, and responsibilities for the core charge nurses. Potential candidates were found among individual volunteers and those recommended by physicians and peers. From those recommendations, RNs were chosen to participate in the core charge nurse program. They attended educational workshops that focused on core charge nurse responsibilities and leadership development, including leadership styles, decision making, operation improvement, listening techniques, and confident communication. Results: Twenty-four nurses underwent training and education and assumed the charge nurse role. There was a moderate decrease in diversion hours, in addition to a reduction in staff turnover since inception of the core charge role. Recommendations: The core charge nurse role is highly recommended for emergency departments seeking strong leadership and management of ED communications, staffing, and operations. Further studies are necessary to determine relationships between the core charge nurse group, job satisfaction, diversion hours, and lengths of stay for ED patients.
June 2004
JOURNAL OF EMERGENCY NURSING
30:3
209