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Utilization of Nurse Practitioners in a Hospital-Based Observation Unit
POSTER ABSTRACTS
Poster Abstracts From the ENA 2005 Annual Meeting The following Poster Abstracts were presented at the 2005 Emergency Nurses Assocation’s Annual Meeting, September 14-17, Nashville, Tennessee. Contact information is provided to facilitate communication with the researchers. Poster abstracts presented at the 2005 ENA Annual Meeting are appearing in the October, February, April, and June issues of the Journal.
J Emerg Nurs 2006;32:125-30. 0099-1767/$32.00 Copyright n 2006 by the Emergency Nurses Association.
425-O Utilization of Nurse Practitioners in a Hospital-Based Observation Unit. Kristi Vaughn, RN, MN, CEN, ACNP-CS, Oregon Health & Science University, 3181 Sam Jackson Park Rd. CDW-EM, Portland, OR 97239 Clinical Topic: The purpose of this project was to describe how utilization of emergency department (ED) nurse practitioners could provide an alternative to medical management of observation-unit patients. Observation units can be extensions of the emergency department, designed to decrease inpatient bed use and promote safe, expedient patient care. In most settings, physicians manage ED patients while also providing ongoing care for observation patients. A new model of ED observation care management was developed utilizing nurse practitioners independently to manage observation-unit patients. Observation patients have acute problems that are anticipated to resolve or improve within 24 to 48 hours of treatment. Implementation: In July 1997, our Level I University Hospital Emergency Department opened a 10-bed observation unit. Initially, a staff emergency physician and nurse practitioner or resident provided patient care management in the observation unit. After one year, a new model was developed so that nurse practitioners could be solely responsible for managing the observationunit patients from 7:00 a.m. to 1:00 a.m. A staff physician was assigned to the observation unit from 8:00 a.m. to 11:00 a.m. to assist with final patient disposition. Also from1:00 a.m. to 7:00 a.m., the night shift staff physicians were responsible for admitting patients to the unit and providing ongoing patient management. The nurse practitioners conducted history and physical exams, developed differential diagnoses, and determined the need for additional testing, pharmacological management, consultation, and disposition of the observation patients. Outcomes: Over the last seven years, the observation unit census has doubled, with an average census of seven patients per day. The average length of stay is 16 hours, and 84 % of the patients are discharged home. The majority of complaints admitted to the observation unit include minor closed head injury, blunt chest and abdominal trauma, low-risk chest pain, dehydration, cellulitis, bronchiolitis, asthma, and chronic obstructive disease exacerbation. Critically ill or complex patient-care problems and
April 2006
JOURNAL OF EMERGENCY NURSING
32:2
125
POSTER ABSTRACTS
children less than 8 weeks of age are excluded. Utilizing nurse practitioners in this ED observation unit has provided more physician satisfaction, decreased overcrowding, and increased efficiency in the emergency department. Recommendations: Recommendations for furthering this work include: Conducting a retrospective study to determine any change in patient outcomes since the operational changes in the observation unit were implemented. Developing and administering observation-unit satisfaction surveys to both clinical staff and patients to measure their satisfaction with the program. Ongoing reviewing and updating of the program’s policies, procedures, and staffing. Identifying other methods or techniques that could be used to evaluate the success of this program (qualitative and quantitative). doi: 10.1016/j.jen.2005.12.027
426-O An Algorithm to Improve a Nurse’s Sense of Effectiveness in Triaging Psychiatric Emergencies. Julie Westman, RN, BSN, MEd, CEN; Twyla Rickman, RPN; Suzanne Gray, RN, BSN, MEd, Providence Health Care, St. Paul’s Hospital, 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada Clinical Topic: In the past two years, triage nurses working at a Canadian inner-city hospital have experienced a 300% increase in the number of psychiatric patients presenting to the emergency department (ED). Coinciding with this dramatic increase was the critical need for more effective ways of triaging this patient population. Nurses completing needs-assessment surveys have repeatedly identified psychiatric emergencies as one of the most challenging patients to triage. Following a comprehensive review of the literature and consultation with practitioners experienced in this area, two educators developed a decision-making algorithm to assist nurses in the triage of psychiatric emergency patients. An anticipated outcome of this project was to increase the triage nurse’s sense of effectiveness when dealing with psychiatric emergencies. Implementation: The following implementation plan was developed based on the recommendations of this ED’s triage and psychiatric nurses, as well as a nurse researcher from the University of British of Columbia: 1) Design a survey and interview a random sample of triage nurses currently working in this facility’s emergency department; 2) Educate the department staff regarding application of the decision-making algorithm during biannual education days; and 3) Conduct follow-up surveys with the triage nurses, assessing changes in their sense of effectiveness managing psychiatric emergency patients. Outcomes: The results of the surveys are currently unavailable at the time of this writing. The preliminary interviews are underway. The education sessions are scheduled for Jan. 31 and Feb. 7, 14, 21, and 28, 2005, and the follow up interviews will be conducted throughout March 2005. Through application of the proposed decision-making algorithm, it is anticipated that nurses will experience an increased sense of effectiveness when triaging psychiatric patients. Outcomes will be available May 2005.
126
Recommendations: The Decision Making Algorithm for Triaging Psychiatric Emergencies may be a valuable tool for promoting the nurse’s sense of effectiveness when triaging psychiatric patients. Based upon project outcomes, the decision-making algorithm will be used in a nursing research study. The intention will be to involve other emergency departments in the area. doi: 10.1016/j.jen.2005.12.028
427-O Integrating Pediatric Disaster Care into the Hospital Emergency Incident Command System (HEICS): Using Job Action Sheets for Pre-Event Planning. Elisabeth K. Weber, RN, MA, CEN ; Dawn A. Anthony, RN, MSN, CNP; Gail Tagney, RN, MSN, Children’s Memorial Hospital, 2300 N. Children’s Plaza, Box 140, Chicago, IL 60614 Clinical Topic: The purpose of this project was to develop pediatric-specific job action sheets (JAS) entitled Pediatric Unit Leader and Pediatric Logistics Unit Leader to provide tools for pediatric disaster planning for use within the Hospital Emergency Incident Command System (HEICS). This project was funded through the Chicago Department of Public Health (CDPH) Health Resources & Services Administration (HRSA) bioterrorism preparedness funds. All 33 hospitals receiving grant funds were expected to include plans and resources for taking care of children within their disaster plans. Implementation: A citywide needs assessment through the CDPH determined that many hospitals in Chicago were seeking tools and assistance with pediatric disaster planning and care. The JAS were developed by the authors and critiqued by the members of the Bioterrorism (BT) Preparedness Pediatric Sub-committee, one of several citywide committees. They were disseminated to 33 city hospitals and interested suburban hospitals through both an educational conference and a presentation at a monthly HRSA grant recipient All Hospital Meeting in November 2004. In addition to the JAS, all hospitals also received training DVDs of presentations by national experts, a BT resource manual (BioTerryk), and medical and safety checklists. Outcomes: All Chicago hospitals had implemented HEICS during an earlier grant cycle. Effectiveness of the pediatric JAS will be determined during BT preparedness drills in 2005. Ten of the 33 HRSA-funded hospitals will participate in a voluntary onsite pediatric consultation and review of their disaster plans during the first two quarters of 2005. The consultation component is a grant deliverable for Children’s Memorial Hospital. Recommendations: Integration of pediatric-care planning prior to an actual disaster will ensure that the burden of pediatric care does not fall solely to emergency-nurse and emergency-department providers. Sharing tools developed by pediatric experts and encouraging hospitals to integrate these tools before an actual incident should enhance care during a disaster. It is recommended that all hospitals utilizing the HEICS model consider implementation of pediatric JAS. It is also recommended that the HEICS-IV committee review these documents for inclusion in the upgrade to HEICS that is scheduled for publication in 2005. doi: 10.1016/j.jen.2005.12.029
JOURNAL OF EMERGENCY NURSING
32:2
April 2006
Poster Abstracts From the ENA 2005 Annual Meeting The following Poster Abstracts were presented at the 2005 Emergency Nurses Assocation’s Annual Meeting, September 14-17, Nashville, Tennessee. Contact information is provided to facilitate communication with the researchers. Poster abstracts presented at the 2005 ENA Annual Meeting are appearing in the October, February, April, and June issues of the Journal.
J Emerg Nurs 2006;32:125-30. 0099-1767/$32.00 Copyright n 2006 by the Emergency Nurses Association.
425-O Utilization of Nurse Practitioners in a Hospital-Based Observation Unit. Kristi Vaughn, RN, MN, CEN, ACNP-CS, Oregon Health & Science University, 3181 Sam Jackson Park Rd. CDW-EM, Portland, OR 97239 Clinical Topic: The purpose of this project was to describe how utilization of emergency department (ED) nurse practitioners could provide an alternative to medical management of observation-unit patients. Observation units can be extensions of the emergency department, designed to decrease inpatient bed use and promote safe, expedient patient care. In most settings, physicians manage ED patients while also providing ongoing care for observation patients. A new model of ED observation care management was developed utilizing nurse practitioners independently to manage observation-unit patients. Observation patients have acute problems that are anticipated to resolve or improve within 24 to 48 hours of treatment. Implementation: In July 1997, our Level I University Hospital Emergency Department opened a 10-bed observation unit. Initially, a staff emergency physician and nurse practitioner or resident provided patient care management in the observation unit. After one year, a new model was developed so that nurse practitioners could be solely responsible for managing the observationunit patients from 7:00 a.m. to 1:00 a.m. A staff physician was assigned to the observation unit from 8:00 a.m. to 11:00 a.m. to assist with final patient disposition. Also from1:00 a.m. to 7:00 a.m., the night shift staff physicians were responsible for admitting patients to the unit and providing ongoing patient management. The nurse practitioners conducted history and physical exams, developed differential diagnoses, and determined the need for additional testing, pharmacological management, consultation, and disposition of the observation patients. Outcomes: Over the last seven years, the observation unit census has doubled, with an average census of seven patients per day. The average length of stay is 16 hours, and 84 % of the patients are discharged home. The majority of complaints admitted to the observation unit include minor closed head injury, blunt chest and abdominal trauma, low-risk chest pain, dehydration, cellulitis, bronchiolitis, asthma, and chronic obstructive disease exacerbation. Critically ill or complex patient-care problems and
April 2006
JOURNAL OF EMERGENCY NURSING
32:2
125
POSTER ABSTRACTS
children less than 8 weeks of age are excluded. Utilizing nurse practitioners in this ED observation unit has provided more physician satisfaction, decreased overcrowding, and increased efficiency in the emergency department. Recommendations: Recommendations for furthering this work include: Conducting a retrospective study to determine any change in patient outcomes since the operational changes in the observation unit were implemented. Developing and administering observation-unit satisfaction surveys to both clinical staff and patients to measure their satisfaction with the program. Ongoing reviewing and updating of the program’s policies, procedures, and staffing. Identifying other methods or techniques that could be used to evaluate the success of this program (qualitative and quantitative). doi: 10.1016/j.jen.2005.12.027
426-O An Algorithm to Improve a Nurse’s Sense of Effectiveness in Triaging Psychiatric Emergencies. Julie Westman, RN, BSN, MEd, CEN; Twyla Rickman, RPN; Suzanne Gray, RN, BSN, MEd, Providence Health Care, St. Paul’s Hospital, 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada Clinical Topic: In the past two years, triage nurses working at a Canadian inner-city hospital have experienced a 300% increase in the number of psychiatric patients presenting to the emergency department (ED). Coinciding with this dramatic increase was the critical need for more effective ways of triaging this patient population. Nurses completing needs-assessment surveys have repeatedly identified psychiatric emergencies as one of the most challenging patients to triage. Following a comprehensive review of the literature and consultation with practitioners experienced in this area, two educators developed a decision-making algorithm to assist nurses in the triage of psychiatric emergency patients. An anticipated outcome of this project was to increase the triage nurse’s sense of effectiveness when dealing with psychiatric emergencies. Implementation: The following implementation plan was developed based on the recommendations of this ED’s triage and psychiatric nurses, as well as a nurse researcher from the University of British of Columbia: 1) Design a survey and interview a random sample of triage nurses currently working in this facility’s emergency department; 2) Educate the department staff regarding application of the decision-making algorithm during biannual education days; and 3) Conduct follow-up surveys with the triage nurses, assessing changes in their sense of effectiveness managing psychiatric emergency patients. Outcomes: The results of the surveys are currently unavailable at the time of this writing. The preliminary interviews are underway. The education sessions are scheduled for Jan. 31 and Feb. 7, 14, 21, and 28, 2005, and the follow up interviews will be conducted throughout March 2005. Through application of the proposed decision-making algorithm, it is anticipated that nurses will experience an increased sense of effectiveness when triaging psychiatric patients. Outcomes will be available May 2005.
126
Recommendations: The Decision Making Algorithm for Triaging Psychiatric Emergencies may be a valuable tool for promoting the nurse’s sense of effectiveness when triaging psychiatric patients. Based upon project outcomes, the decision-making algorithm will be used in a nursing research study. The intention will be to involve other emergency departments in the area. doi: 10.1016/j.jen.2005.12.028
427-O Integrating Pediatric Disaster Care into the Hospital Emergency Incident Command System (HEICS): Using Job Action Sheets for Pre-Event Planning. Elisabeth K. Weber, RN, MA, CEN ; Dawn A. Anthony, RN, MSN, CNP; Gail Tagney, RN, MSN, Children’s Memorial Hospital, 2300 N. Children’s Plaza, Box 140, Chicago, IL 60614 Clinical Topic: The purpose of this project was to develop pediatric-specific job action sheets (JAS) entitled Pediatric Unit Leader and Pediatric Logistics Unit Leader to provide tools for pediatric disaster planning for use within the Hospital Emergency Incident Command System (HEICS). This project was funded through the Chicago Department of Public Health (CDPH) Health Resources & Services Administration (HRSA) bioterrorism preparedness funds. All 33 hospitals receiving grant funds were expected to include plans and resources for taking care of children within their disaster plans. Implementation: A citywide needs assessment through the CDPH determined that many hospitals in Chicago were seeking tools and assistance with pediatric disaster planning and care. The JAS were developed by the authors and critiqued by the members of the Bioterrorism (BT) Preparedness Pediatric Sub-committee, one of several citywide committees. They were disseminated to 33 city hospitals and interested suburban hospitals through both an educational conference and a presentation at a monthly HRSA grant recipient All Hospital Meeting in November 2004. In addition to the JAS, all hospitals also received training DVDs of presentations by national experts, a BT resource manual (BioTerryk), and medical and safety checklists. Outcomes: All Chicago hospitals had implemented HEICS during an earlier grant cycle. Effectiveness of the pediatric JAS will be determined during BT preparedness drills in 2005. Ten of the 33 HRSA-funded hospitals will participate in a voluntary onsite pediatric consultation and review of their disaster plans during the first two quarters of 2005. The consultation component is a grant deliverable for Children’s Memorial Hospital. Recommendations: Integration of pediatric-care planning prior to an actual disaster will ensure that the burden of pediatric care does not fall solely to emergency-nurse and emergency-department providers. Sharing tools developed by pediatric experts and encouraging hospitals to integrate these tools before an actual incident should enhance care during a disaster. It is recommended that all hospitals utilizing the HEICS model consider implementation of pediatric JAS. It is also recommended that the HEICS-IV committee review these documents for inclusion in the upgrade to HEICS that is scheduled for publication in 2005. doi: 10.1016/j.jen.2005.12.029
JOURNAL OF EMERGENCY NURSING
32:2
April 2006