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Recommended Citation
West P, Billiar E. Reimagining an Observation Unit to Make Room for More. Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background
In January 2023, the length of stay (LOS) for the observation (OBS) unit was 2.7 days. The care delivery was one of inpatient and observation in which there was little focus on LOS.
Local Problem
There were capacity challenges due to volume in the hospital with multiple overflow units open and extended LOS in the emergency department (ED) which led to increased boarding times of admitted patients.
Method
After working with the performance improvement (LEAN) specialist, the observation leadership identified a team of interdisciplinary stakeholders and began rapid cycle biweekly plan, do, study, act (PDSAs) on the journey to decrease patient LOS. The plan’s first and most crucial step was to start with interprofessional collaboration through nurse-led board rounds, held every four hours by nurse leaders during all shifts. Concurrently frequent meetings were conducted with these interprofessional partners, identifying barriers, and thereby directing prioritization of the OBS patient population. New observation guidelines were established, replacing old inclusion/exclusion criteria, leaving room for a more comprehensive patient population. A daily LOS tool was developed and posted for staff to view. Nurse leaders held frequent fidelity meetings with providers and a daily report was pulled of all OBS patients throughout the hospital to ensure correct placement on the OBS unit.
Results and Conclusions
The percentage of inpatients on the observation unit went from 66% to 15% and the LOS decreased from 2.7 to 1.1 days. In addition, the emergency room LOS decreased from 262 to 228 hours. Scorecards were developed to display nurses discharge and transfer times with a goal of 60 minutes.
Implications for Practice
These best practices have been shared with other Atrium/ Advocate teams. As a bonus, the OBS team now cross-trains to the ED enhancing collaboration, increasing the knowledge and flexibility of both teams and mitigating staffing shortages in the ED.
Document Type
Poster
Publication Date
11-13-2024
Reimagining an Observation Unit to Make Room for More
Background
In January 2023, the length of stay (LOS) for the observation (OBS) unit was 2.7 days. The care delivery was one of inpatient and observation in which there was little focus on LOS.
Local Problem
There were capacity challenges due to volume in the hospital with multiple overflow units open and extended LOS in the emergency department (ED) which led to increased boarding times of admitted patients.
Method
After working with the performance improvement (LEAN) specialist, the observation leadership identified a team of interdisciplinary stakeholders and began rapid cycle biweekly plan, do, study, act (PDSAs) on the journey to decrease patient LOS. The plan’s first and most crucial step was to start with interprofessional collaboration through nurse-led board rounds, held every four hours by nurse leaders during all shifts. Concurrently frequent meetings were conducted with these interprofessional partners, identifying barriers, and thereby directing prioritization of the OBS patient population. New observation guidelines were established, replacing old inclusion/exclusion criteria, leaving room for a more comprehensive patient population. A daily LOS tool was developed and posted for staff to view. Nurse leaders held frequent fidelity meetings with providers and a daily report was pulled of all OBS patients throughout the hospital to ensure correct placement on the OBS unit.
Results and Conclusions
The percentage of inpatients on the observation unit went from 66% to 15% and the LOS decreased from 2.7 to 1.1 days. In addition, the emergency room LOS decreased from 262 to 228 hours. Scorecards were developed to display nurses discharge and transfer times with a goal of 60 minutes.
Implications for Practice
These best practices have been shared with other Atrium/ Advocate teams. As a bonus, the OBS team now cross-trains to the ED enhancing collaboration, increasing the knowledge and flexibility of both teams and mitigating staffing shortages in the ED.
Affiliations
Atrium Cabarrus