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Increasing Emergency Department Throughput through the Implementation of a Nursing Bundle Intervention

Wiggins, Monica M.
Date
2025-05
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DNP Project
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THROUGHPUT IN THE EMERGENCY DEPARTMENT
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Abstract

Problem: The Emergency Department (ED) plays a crucial role in the delivery of healthcare to patients of various acuity levels. The average ED waiting time between the decision to admit and ED departure to an inpatient unit is significantly prolonged. This overwhelming marker emphasizes issues within the ED, notably, efficiency and patient flow. Factors contributing to prolonged wait times include inappropriate patient placement, staffing shortages, and surges in patient volumes. Purpose: The purpose of this quality improvement project is to reduce ED patient length of stay among patients being admitted to the medical-surgical (MS) unit through the implementation of bundled nursing interventions. . Methods: The QI project lead and the multidisciplinary team worked to identify root causes of this problem. A comprehensive evidence review was conducted, and pre-implementation data was gathered to establish a baseline. Interventions were identified based on average ED LOS metrics and the following ED nursing workflows were implemented; the text message-only system, response time constraints, and a specifically curated handoff template. All charge nurses and administrative coordinators (AC) were trained through monthly online meetings and face-to-face Q & A meetings. PACE metrics containing admission times were tracked weekly and the recording of completed bundled intervention use was tracked weekly. Preliminary Results: Preliminary data showed that 81% (39/48) of the qualifying admitted patients received the bundled nursing intervention. The average time for the decision to admit to actual patient transfer for each week ranged from 360 minutes to 1174 minutes, with a median of 587 minutes. Preliminary Conclusion: The bundled nursing intervention achieved a high level of implementation, reflecting good staff compliance and practicality in routine use. However, the median transfer time shows only moderate improvement, with substantial variability remaining due to systemic factors like bed availability and facility challenges. Further data collection and analysis are necessary to confirm trends, reduce variability, and assess the intervention's sustained impact on throughput.

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