Problem to be Resolved:
Emergency department (ED) overcrowding is a national epidemic that threatens public health by compromising patient safety. The Joint Commission requires that hospitals develop processes to eliminate ED overcrowding. Nevertheless, little information is available describing effective, evidence-based nursing practices that decrease overcrowding, create a climate of safety, and improve quality outcomes in the ED environment.
Objectives of the Project:
The aim was to describe how information technology (IT) and innovative nursing practices can be used to decrease overcrowding and improve outcomes in the ED.
Methods:
To decrease overcrowding and improve quality outcomes in the ED, the Center for Nursing at Huntington Hospital developed innovative, evidence-based nursing practices. The cornerstone of these practices was a change in culture to "zero tolerance" for admitted patients being held in the ED. Other key practices included the following: (1) implementation of a hospital-wide, electronic patient tracking board (Horizon Enterprise Visibility Indicators) to improve communication among caregivers and movement of patients throughout the hospital; (2) appointment of an "RN patient flow coordinator"; and (3) development of an IT-based "ED Capacity Management" protocol to deploy additional nursing and support staff as the ED census increases.
Outcomes:
The use of the hospital-wide IT systems and innovative, evidence-based nursing process has resulted in significant decreases in ED overcrowding, improved patient and staff satisfaction, fewer errors and delays in treatment, and fewer patient/family complaints.
Lessons Learned:
Overcrowding in the ED and the overall quality of care provided to ED patients can be significantly improved through the use of IT and innovative, evidence-based nursing practices. First, however, a hospital-wide culture of zero tolerance for holding admitted patients in the ED must be developed to consistently achieve high-quality outcomes.
Section Description
We are pleased to share the paper presentation abstracts from the Summer Institute in Nursing Informatics, Informatics at the Point of Care: A Barrier or a Bridge?, held at the University of Maryland School of Nursing, July 22 to 25, 2009. The program, chaired by Dr Judy Ozbolt, was a great success. Each of the following abstracts was selected for presentation by a peer-review committee.