Admission Nurse Impact on Patient Throughput for Emergency Department Admissions
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Abstract
Problem: The American College of Emergency Physicians asserts that Emergency Department (ED) overcrowding is a result of patient flow problems impacted by workflows across the organization, including the outflow of admitted patients. At a large community hospital in Maryland, the time from the decision to admit to depart was greater than 2 hours. In alignment with Maryland’s Health Services Cost Review Commission’s Emergency Department Dramatic Improvement Effort (EDDIE project) the organization wanted to reduce this to less than 60 minutes, with an interim goal of 110 minutes, a 25% improvement. Purpose: The project aimed to improve patient throughput by decreasing the time from bed assignment to depart by creating and implementing an Admission Nurse (AN) role and workflow for patients admitted to the cardiac acute care unit. Methods: Creating the AN role required redefining responsibilities for each task in the admission process. After the ED provider decides to admit a patient, bed management remained responsible for assigning the patient to a bed. The primary ED nurse completed the electronic SBAR (eSBAR) note. The AN was responsible for transporting the patient from the ED to their assigned room, completing the admission forms within the electronic health record, initiating telemetry if ordered, and orienting the patient to their room. The AN role was piloted one evening each week for 15 weeks. Results: The median decision to admit to depart time for patients admitted by the AN was 11 minutes faster than hospital performance. The median time from bed assignment to admission for patients admitted by the AN was 27 minutes faster than hospital performance, 60 minutes compared to 87. Conclusions: The AN can expedite patient movement and decrease the time from bed assignment to admission. Additional barriers and processes need to be addressed to decrease the overall time from decision to admit to admission including bed availability and alignment of goals between the ED and acute care units.