Expediting a patient’s admission experience

1. Expediting a patient’s admission experience A Nursing Supervisor’s Role Nicole Atkins, RN Nursing 444-35W SUNY Utica Elizabeth Rengal, RN -Preceptor

2. Observed Leadership Role • My leadership role entailed shadowing a registered nurse throughout two of my area hospitals, Albany Memorial Hospital and Samaritan Hospital. Both of these hospitals are part of Saint Peter’s Health Partners and share the same policies, procedures and applications.

3. Project objectives • Efficiently expedite the admission process by facilitating good communication between ED and floor staff • Manage cost via staffing while being mindful of the acuity of patients • Ensure patients receive the most efficient care both physically and monetarily.

4. Significance to nursing • The manner in which our health care industry travels is based specifically on the ability to distribute resources including licenses appropriately. • If we were able to apply specific changes to the issues explored, the nursing process in general make become easier and allow for the nursing profession as a whole to become more desirable and our patient's will be happier.

5. Care logistics and it’s role • Saint Peter's Health Partners has implemented a program via Care Logistics to specifically help communication within the hospital setting. • This program focus's on decreasing fragmented care, ensuring nurses know where their patients are at all times as well as other members of their health care team. • Lastly, the program helps to expedite patient admissions and facilitate better understanding between the emergency department and the hospital floors to ensure a smooth transmission

6. Applying Imogene King’s Theory of Goal Attainment • Imogene King’s theory can easily be applied to the leadership position in which I observed. King purposed that the goal of nursing is “to help individuals maintain their health so they can function in their roles.” (Hood, 2010) The nursing supervisor’s goal, as well as Saint Peter’s Health Partner’s goal is to help ensure our patients obtained the most efficient, effective and expeditious care possible. Nursing’s intervention’s and ways to implement them falls in line with this theory as well, each floor is provided with a care pathway that closely monitor’s how our patients should be progressing specific to their admitting diagnosis.

7. The nursing supervisor’s responsibilities • Albany Memorial and Samaritan Hospital both require a nursing supervisor to help facilitate admissions and distribute them appropriately to their specific floors. • Staffing is an essential requirement of the supervisor, who observes acuity, admissions and discharges and scenarios requiring additional staff • The supervisor is to be present for all called “codes.” She meticulously documents the happenings of each and assists nursing staff and doctors as needed.

8. “Partnering for Excellence” • With the recent creation of Saint Peter’s Health Partner’s, there have been many implementations regarding care logistics. • Goal • “To provide the highest quality comprehensive continuum of integrated health care, supportive housing and community services, especially for the needy and vulnerable.” -Saint Peter’s Health Partners

9. Description of my Quest • Utilizing the role of a nursing supervisor, the goal of this project was to evaluate and improve the process of emergency department arrival to hospital floor admission. Input was obtained from nurses on in the emergency department as well as nurses from one of the most acute floors, the telemetry unit. In addition, cost of extended stay and importance of goal setting and proper implementation of nursing interventions was explored.

10. The best resources • My best resources for ideas to help expedite the admission process were the nurses that facilitate the process. Some suggestions included- • “Hospitalist staff to see patient, examine and write orders in a timely fashion.” • “Increasing RN’s on the floor would help significantly” • “Float nurses to help with admissions on floor” • “Eliminate LPN’s, they can’t take admissions and increase RN’s patient load”

11. Verification of importance through numbers An article entitled “The impact of delays to admission from the emergency department on inpatient outcomes” pinpointed the precise reason this issue needs to be addressed and improved, concluding that if the length of stay in the emergency department was greater than 12 hours, it was associated with a 12.4% longer inpatient length of stay as well as an 11% increase in their inpatient cost. (Huang, Thind, Dreyer, & Zaric, 2010)

12. The united States emergency room statistics Number of visits: 129.8 million Number of injury-related visits: 37.9 million Number of visits per 100 persons: 42.8 Percent of visits with patient seen in fewer than 15 minutes: 25.1% Percent of visits resulting in hospital admission: 13.3% Percent of visits resulting in transfer to a different (psychiatric or other) hospital: 2.1% (CDC, 2013)

13. My implementation process • By the end of my clinical preceptorship, I was able to perform the role of nursing supervisor efficiently. • Establishing trust with the seasoned nurses given our generational gap was my largest challenge. • I assertively and respectfully addressed the hospitalist’s lax manner with regards to writing orders and expressed the stress it placed on my staff.

14. Did I meet my objectives? • I believe I successfully achieved my goals with regards to my leadership project. With the help of my preceptor and the significant changes implemented by Catholic Health East, my concerns regarding patient admissions as well as health care cost were addressed thoroughly. Because these ideas are so new, there is no concrete research to state whether they will be successful long term. I was able to determine the acuity of patients and place them on the appropriate floor to be admitted, as well as ensure patient's stays are not prolonged. My leadership experience was not only successful but inspiring.

15. references • Hood , L. J. (2010). Leddy & pepper's conceptual bases of professional nursing. (7 ed., p. 176). Philadelphia, PA: Wolters Kluwer Health. • Huang, Q., Thind, A., Dreyer, J. F., & Zaric, G. S. (2010). The impact of delays to admission from the emergency department on inpatient outcomes. BMC Emergency Medicine, 10(16), doi: 10.1186/1471-227X-10-16 • CDC. (2013, May 30). Faststats- emergency department visits. Retrieved from http://www.cdc.gov/nchs/fastats/ervisits.htm • Saint Peter's Health Partners. (2013) Partnering for excellence care logistics application training. [Powerpoint Slides]