2019 Research Forum

Implementing Standardized Procedures to Improve Throughput in the Immediate Care Center

Gloria Bae RN, Maria Espinosa RN, Albeza Guerrero RN, Huong Lambert RN, Sara Lopez RN, Andrea Melton RN, Gloria Torres RN

Introduction

Nursing staff were educated on standardized procedures through group huddles before start of shifts. Standardized procedures were incorporated visually through posters which were posted throughout the Emergency Department for staff reference. Data for patient wait times in April/May 2017 were compared to April/May 2018. Methods

Conclusions The data collected supports that the time from patient arrival to provider evaluation lengthened from 2017 to 2018. Furthermore, in April/May 2017, there were 169 Voluntary Withdrawals (VWD), whereas in April/May 2018 there were 301 VWDs. Consequently, education of staff on standardized procedures did not decrease throughput in the ICC. Our results demonstrate that the incorporation of standardized procedures did not have a positive effect on throughput. Mid-level providers in the ICC have made a positive contribution to the throughput process by expediting the evaluation process and by increasing the provider availability base. As such, an increase in mid-level providers in the ICC may decrease the patient arrival to provider evaluation wait times. References Bradley, V. M. (2005). Placing emergency department crowding on the decision agenda. Journal Of Emergency Nursing: JEN: Official Publication Of The Emergency Department Nurses Association , 31 (3), 247-258. Hesse, C., Assid, P., Jackson, P., & Schmitz, J. (May 2017). Emergency Department Throughput. Emergency Nurses Association, 1-13. Oredsson, S., Jonsson, H., Rognes, J., Lind, L., & Goransson, K. (2011). A systematic review of triage related interventions to improve patient flow in emergency department. Scandinavian Journal of Trauma, Resuscitation & Emergency Medicine, 19-43.

As nurses in the Emergency Department, we strive to serve our patients as efficiently as possible. With 62% of hospitals reporting working over capacity, it becomes difficult to expedite patient care (Bradley, 2005). Studies have shown that overcrowding can lead increased inpatient stay by 0.8% and increased cost per admission by 1% (Hesse C. & Assid, 2017). Patient visits to the Immediate Care Center (ICC) are for urgent-care purposes and, as such, should be efficient. Studies have shown that having an ICC, or fast-track, can help decrease waiting time by 20% and length of stay by 18% (Orrendson & Jonnson, 2011). However, patients oftentimes wait many hours before they even see a provider. In a medical situation, this is time that could be better utilized, such as implementing standardized procedures, so that results are available by the time a provider evaluates the patient, thus expediting the patient’s stay in the ICC, decreasing their length of stay in the hospital, and increasing patient satisfaction. In the ICC, there can be as much as a 1:12 nurse- to-patient ratio and the patient’s wait time can be many hours. Many patients choose to leave rather than wait for medical care (Voluntary Withdrawal or VWD). We wanted to find a more efficient method to serve our ICC patients, so that they can get the medical treatment they need in a safe and timely way. The clinical significance would be that (1) first-year RNs would be allowed to assign hospital standardized procedures for specific medical events (e.g., chest pain, asthma) and (2) patient’s wait time will be decreased resulting from labs and/or EKGs or imaging results being readily available to providers upon patient evaluation. By implementing standardized procedures, the objectives were to: • Improve throughput in the ICC. • Re-educate nursing staff on standardized procedures. • Increase patient safety and satisfaction. • Increase patient satisfaction may result in patient return for repeat services or patient referral.

The data compiled showed that the overall patient wait times were unchanged from 2017 to 2018. Additionally, the average number of patients seen within the ICC remained consistent from 2017 to 2018. The biggest difference came from the wait time to be seen by a provider or patient arrival to provider. For 2017, the average wait time was approximately 2 hours. In 2018, however, the average wait time before being seen by a provider was over 3 hours. Results

Acknowledgements

Objectives

Michelle Peterson, MSN, RN (Clinical Director) Susie Maderosian, BSN, RN (Clinical Supervisor) Pamela Gavin, BSN, RN (NRP Coordinator) Ana Palacio, BSN, RN (NRP Facilitator) Joan Buddecke, MSN, RN (IRB Manager) Emergency Department Nurses, Physicians, Physician Assistants, and Nurse Practitioners

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