Abstract
Purpose: Nursing handoff from ED to inpatient teams was identified as an area of opportunity for the organization. Bed Ready to Out is an initiative that focused on decreasing the amount of time a patient spends in the ED once a bed has been assigned, improving admission throughput. Design: Through the use of the DMAIC (Define, Measure, Analyze, Improve and Control) process improvement methodology, a multi-department team including representation from the ED, inpatient nursing, and process improvement developed a streamlined approach to nursing handoff by eliminating a full verbal report. The team focused on utilizing standardized reports available in the Epic system, establishing time expectations, and defining roles and responsibilities within the handoff process. Setting: The ED at an urban, academic, level one trauma center, with approximately 80,000 visits in fiscal year 2017. Participants/Subjects: All ED and inpatient nursing staff throughout the organization were educations and played an active role in the success of this process improvement project. Nursing leadership, management engineering, and educators were influential in establishing the guidelines and supporting staff to make influential changes to this process. Methods: The emergency department leaders, in conjunction with our management engineering teams and inpatient nursing leaders, developed a process for improved nursing handoff of ED patients, which eliminated the need for a full verbal report. In place of a full verbal report, nursing staff were educated on how to located pertinent information with the Epic ED narrator. The new handoff process rolled out to all ED and inpatient nursing staff in numerous ways. Methods of communication included system wide communications via email, one-on-one education by nurse educators, and discussions during monthly staff meetings held by organizational leaders. A flow chart was created that outlined the step-by-step process in which handoff was expected to be communicated and all staff had easy access on their units to this chart. Results/Outcomes: Patients in the ED wait for extended periods of time upon decision to admit to the hospital. Initial baseline data gathered from fiscal year 2016 indicates the bed ready to out median time was 75 minutes. This time included verbal handoff full report, and preparing the patient for transport, as well as transfer to the nursing unit. Post-education and during the piloting period (December 19, 2016 to January 8, 2017) data indicates a median time of 58 minutes, which demonstrates success from the original 75 minutes. As of December 2017 the median bed ready to out time is 53 minutes. Over the course of implementation, the ED has ranged from a median of 47 minutes (July 2017) to 60 minutes (March 2017). Implications: The success of this new process has created a guideline for nurse to nurse handoff of ED patients. By having a standardized process in place, patients are transferred to an inpatient unit much quicker. Reducing the amount of time a patient spends in an ED treatment space impacts wait times and patient satisfaction scores, as well as overall ED throughput.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Patient Throughput, Bed Ready to Out, ED to Inpatient Ward Transfer
Recommended Citation
Maitland, Jillian; Dye, Mallory; Naegele, Miranda; Crow, Danielle; Stevenson, Sara; and Stuckey, Matthew, "Bed ready to out - An epic approach to nursing handoff" (2019). General Submissions: Presenations (Oral and Poster). 88.
https://www.sigmarepository.org/gen_sub_presentations/2018/posters/88
Conference Name
Emergency Nursing 2018
Conference Host
Emergency Nurses Association
Conference Location
Pittsburgh, Pennsylvania, USA
Conference Year
2018
Rights Holder
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Bed ready to out - An epic approach to nursing handoff
Pittsburgh, Pennsylvania, USA
Purpose: Nursing handoff from ED to inpatient teams was identified as an area of opportunity for the organization. Bed Ready to Out is an initiative that focused on decreasing the amount of time a patient spends in the ED once a bed has been assigned, improving admission throughput. Design: Through the use of the DMAIC (Define, Measure, Analyze, Improve and Control) process improvement methodology, a multi-department team including representation from the ED, inpatient nursing, and process improvement developed a streamlined approach to nursing handoff by eliminating a full verbal report. The team focused on utilizing standardized reports available in the Epic system, establishing time expectations, and defining roles and responsibilities within the handoff process. Setting: The ED at an urban, academic, level one trauma center, with approximately 80,000 visits in fiscal year 2017. Participants/Subjects: All ED and inpatient nursing staff throughout the organization were educations and played an active role in the success of this process improvement project. Nursing leadership, management engineering, and educators were influential in establishing the guidelines and supporting staff to make influential changes to this process. Methods: The emergency department leaders, in conjunction with our management engineering teams and inpatient nursing leaders, developed a process for improved nursing handoff of ED patients, which eliminated the need for a full verbal report. In place of a full verbal report, nursing staff were educated on how to located pertinent information with the Epic ED narrator. The new handoff process rolled out to all ED and inpatient nursing staff in numerous ways. Methods of communication included system wide communications via email, one-on-one education by nurse educators, and discussions during monthly staff meetings held by organizational leaders. A flow chart was created that outlined the step-by-step process in which handoff was expected to be communicated and all staff had easy access on their units to this chart. Results/Outcomes: Patients in the ED wait for extended periods of time upon decision to admit to the hospital. Initial baseline data gathered from fiscal year 2016 indicates the bed ready to out median time was 75 minutes. This time included verbal handoff full report, and preparing the patient for transport, as well as transfer to the nursing unit. Post-education and during the piloting period (December 19, 2016 to January 8, 2017) data indicates a median time of 58 minutes, which demonstrates success from the original 75 minutes. As of December 2017 the median bed ready to out time is 53 minutes. Over the course of implementation, the ED has ranged from a median of 47 minutes (July 2017) to 60 minutes (March 2017). Implications: The success of this new process has created a guideline for nurse to nurse handoff of ED patients. By having a standardized process in place, patients are transferred to an inpatient unit much quicker. Reducing the amount of time a patient spends in an ED treatment space impacts wait times and patient satisfaction scores, as well as overall ED throughput.