Document Type
DNP - Open Access
Award Date
2024
Degree Name
Doctor of Nursing Practice (DNP)
Department
Graduate Nursing
First Advisor
Dannica Callies
Abstract
Background: Long emergency department (ED) length of stay (LOS) is associated with increased mortality, delay in care, longer inpatient (IP) stays, readmission risk, poor patient satisfaction, and opportunity for error. Within the ED LOS is a quality indicator measuring the time a provider determines a patient will be admitted to the time the patient leaves the ED for an IP unit, called ED-2. Prolonged ED-2 indicates impaired ED output.
Local Problem: Despite previous interventions, the ED-2 at a rural Midwest hospital was about 63.5 minutes; the goal set forth by the Centers for Medicare and Medicaid is 35 minutes or less.
Methods: A review of literature aided in developing evidence-supported interventions to reduce ED-2, which included admission prediction near the time of patients’ arrival to the ED and proactive IP bed allocation. The ED-2 was compared 3 months pre-post implementation. Additionally, staff perceptions and experiences surrounding the change were evaluated.
Interventions: The Sydney Triage to Admission Risk Tool (START) was selected to aid ED nurses in predicting patient admissions at the time of triage. Emergency department nurses and IP bed managers were educated on START and proactive bed allocation. When a patient had a START score of 17 or greater, ED staff contacted the IP bed manager to begin the bed assignment process.
Results: A 1-minute reduction in ED-2 postintervention was observed, however, the difference was not statistically significant. Staff perceptions were variable. Of those that completed the survey, most saw value in the intervention, but there were notable barriers impacting its success.
Conclusions: The lack of postintervention ED-2 reduction, accuracy of START, and staff perceptions differed from the findings of previous studies, however, staff indicated a desire to continue the process change with modifications.
Publisher
South Dakota State University
Rights
Copyright © Jolyn Sackmann
Recommended Citation
Sackmann, Jolyn, "Reducing Emergency Department Decision to Admit to Disposition Time Using the Sydney Triage to Admission Risk Tool" (2024). Doctor of Nursing Practice (DNP) Practice Innovation Projects. 208.
https://openprairie.sdstate.edu/con_dnp/208