All aboard: Improving the admission and boarding procedures in the acute care setting
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Increased admission rates and lack of bed capacity affects patient flow through the hospital, which results in care delays. Delayed admissions lead to increased length of stay, rise in hospital costs, and emergency department (ED) boarding, which puts patients at a higher risk for adverse medical events and mortality. In response to an acute delay identified by Centers for Medicare & Medicaid Services (CMS), a group of Clinical Nurse Leader (CNL) students were utilized in the admission nurse role to aid in improving timeliness of care. The purpose of this evidence-based quality improvement project was to enhance patient outcomes by reducing delays in care. Data were collected over a thirteen-month period, including pre and post implementation, for the admission nurse role from January 2018 through January 2019. A total of 240 charts were reviewed to investigate time difference of order entry, ED boarding, and admission assessment times. Additionally, hospital data for quality and safety measures were also reviewed during the evaluated period. Furthermore, 82 staff members were surveyed concerning the admission nurse role via SurveyMonkey®. The results revealed significant improvements in timeliness of order entry and admission assessment. Patient safety and quality metrics improved, and nurses experienced more efficient workflows leading to increased nurse satisfaction. Recommendations from this study include continued systems improvement and innovations, such as implementation of the admission nurse role, formation of interdisciplinary teams to address ED boarders, and utilization of the Clinical Nurse Leader in the ED.|Keywords: Emergency Department throughput; admission nurse role; admission, discharge, transfer nurse; missed care; delayed admission; ED boarding, Clinical Nurse Leader; quality care; and patient outcomes.
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