Recommended Citation
Tavs K. The solution to safe patient handoffs & improved patient flow: Creation of the Admission, Discharge, Transfer (ADT) Nurse. Quality Improvement podium presentation at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.
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Presentation Notes
Quality Improvement podium presentation at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.
Abstract
Background: The 2021 Culture of Safety Survey demonstrated patient handoffs as the greatest opportunity for improvement; specifically, the transition between the Emergency Department (ED) and inpatient (IP) units. Barriers to safe handoff included workflow between theunits, nonadherence to bedside report and lack of telemetry boxes in the ED, delaying patient transfer, and creating increased risk for patient safety.
Local Problem: June 2021 data
- Three ED patient elopements, two left against medical advice, 15 left without being seen after triage, and three left without being seen prior to triage.
- Average disposition to admit time of 112 minutes (goal < 39 minutes)
- 24.9% inpatient discharges before noon (goal > 30%).
Method: A sub-group of key stakeholders determined three solutions to the problem: 1) Create a clinical nursing leadership role that admits, discharges, and transfers (ADT) patients to improve throughput. 2) The ADT nurse facilitates handoff at the ED bedside and pulls the patient to the IP unit 3) Store five telemetry boxes in ED for accessibility. Process mapping was used to add the ADT nurse admission process to current workflow. The pilot included ED and two medical-surgical units. Timeframe was month of August, Monday-Friday, 0900-2100, with education provided to all team members involved.
Results/Conclusions: A post-intervention survey revealed increased staff satisfaction in patient safety, teamwork, efficiency, and use of bedside report. Efficiency improved as evidenced by a decrease in the “Bed Ready-Admit” metric by 50% for an average of 28 minutes, decreased “Length Without Being Seen after Triage” metric by nearly 50% and “Length Without Being Seen before Triage” and “Eloped” metrics by 33%, and 100% dual skin assessments completed upon admission to IP units. The outcome of the pilot is approval of 1.8 FTE ADT nurse positions at Aurora Medical Center Grafton.
Document Type
Oral/Podium Presentation
Affiliations
Aurora Medical Center Grafton