Summer Nursing s Highest International Recognition for Excellence and Leadership

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1 MAGNET Illuminations Summer 2012 Nursing s Highest International Recognition for Excellence and Leadership Our Nursing Mission To provide the right patient care, every time, ensuring the highest level of quality nursing care and patient satisfaction. NEW KNOWLEDGE, INNOVATIONS, AND IMPROVEMENTS In this issue: 3 Magnet Model Component: New Knowledge, Innovations, and Improvements 4 Nursing Research Fellowship Program 6 Nurse Leaders: Cheryl Lenhart and Karen Weimer 7 Nursing Education, Research, and Evidence Based Practice Council 8 Theater in the Round : An Innovative Educational Model 10 Quality: Optimal Discharge Planning Program 12 Service Excellence: Emergency Services Granted Magnet status, UPMC St. Margaret has the responsibility to contribute to patient care, its hospital, and the Mary Barkhymer health care profession in terms of New Knowledge, Innovations, and Improvements. Nurses in an empowered organization, such as ours, have a thirst for knowledge and to make continuous improvements. Nurses conduct research, apply evidence-based practice to their daily work, and strive to implement best practices for their patients. I am constantly amazed at the work our nurses do to evaluate current practices, seek improved processes, and with their willingness to change in order to help our patients. As nurses, we are never finished learning and refining our craft. New discovery fuels our ambition and creates improved care and outcomes. That s why New Knowledge, Innovations, and Improvements is one of the five Magnet components. As nurses of UPMC, we are a part of Life Changing Medicine. We change practice to improve the quality care provided to our patients. An organization that embodies New Knowledge, Innovations, and Improvements encompasses: l An environment that encourages learning and enhanced professional practice l Nurses using new models of care and evidence to advance patient care l Nurses advancing the science of health care through research to generate new knowledge l Nurses having an eye for improvements always seeking better, safer methods l Nurses having a moral and professional responsibility to contribute to the advancement of patient care supporting UPMC St. Margaret s mission to provide the right patient care, every time (continued on page 2) UPMCStMargaret.com

2 New Knowledge, Innovations, and Improvements (continued from page 1) New Knowledge = Research Why is this important? Research promotes the creative use of science. Nurses engaged in problemsolving reach outside of their comfort zone to contribute to the ultimate patient experience. Nurses involved in research and evidence-based practice have the ability to provide input into policy and procedure development. Using evidence-based practice, UPMC St. Margaret nurses are encouraged to design and implement clinical projects on their units that improve nurse-sensitive and patient outcome indicators. Innovations = Using Evidence-Based Practice Who do you think of in terms of innovation? l Steve Jobs changing the technology industry l Walt Disney enriching our lives through imaginative entertainment for children and adults l John F. Kennedy s vision to get man on the moon, developing technology along the way l Florence Nightingale observing evidence of infections and changing health care practice to achieve improved patient outcomes Nursing practice is innovative; implementing new ways to achieve high-quality, effective, and efficient patient care through the evaluation and allocation of technology and information systems, as well as the participation in architectural and space design to support practice. UPMC St. Margaret s research and innovations were showcased at our 2012 Nursing Research Symposium. Read on in this issue of Magnet Illuminations, as we describe the New Knowledge, Innovations, and Improvements component further and highlight the work of our nursing research fellows. Sincerely, Mary Barkhymer, RN, MSN, MHA, CNOR Vice President, Patient Care Services, and Chief Nursing Officer (CNO) UPMC St. Margaret The ability to innovate is only as good as how one can accept changes and take risks. Randy Pausch 2 Magnet Illuminations

3 MAGNET MODEL COMPONENT: NEW KNOWLEDGE, INNOVATIONS, AND IMPROVEMENTS Submitted by Cheryl Lenhart, BSN, HRM, RN-BC UPMC St. Margaret s Nursing Education, Research, and Evidence Based Practice Council has spent the last 18 months trying to promote nursing research and evidence-based practice, and is succeeding as it flourishes. The hospital has four nursing research fellows and four nursing research projects. Our nurse educators are working with Clinical III candidates to evaluate existing practices and search for new methods. The No Pulling project, which began last year, was an evidence-based project completely driven by nursing unit staff. The Ask-It campaign continues to be successful in cultivating questions from nursing staff and has challenged us to inquire, review evidence, and change practice. The Nursing Innovation Summit 2012: Hot Topics in Nursing, sponsored by UPMC St. Margaret, showcased and shared innovative ideas and insights in nursing education, leadership, clinical practice, research, and technology. The objective of the Summit was to draw attention to innovative ideas in nursing and to foster professional discussion and collaboration among nurses. The New Knowledge, Innovations, and Improvements component includes new models of care, application of existing evidence, new evidence, and visible contributions to the science of nursing. UPMC St. Margaret has adopted Relationship-Based Care as its model for nursing care and the Nursing Division is working towards enhancing the characteristics that strengthen the nursepatient relationship: daily patient goal setting, the variable rounder model, A Just Culture patient safety concept, interdisciplinary working groups, and professional certification evidence to nursing s commitment to patients. The focus for the future is the difference that our nurses make to patient outcomes and to the nursing profession. Our Nursing Education Department, Professional Practice Councils, and Nursing Division work extremely hard to ensure educational opportunities, programs, and conferences are provided to our nurses every month. Nurses at every level are encouraged to participate in such learning opportunities within UPMC, locally, regionally, and at nursing professional organization conferences and workshops. The term innovation means to renew or change. There are generally three factors that comprise the concept of innovation: the idea itself, the creativity brought by the individuals and teams during the innovative process, and the environment that sustains the idea. There are two types of innovative processes: l User-driven involves ideas that improve existing products or services l Disruptive involves ideas that are transformative in nature; disrupting the norm by thinking differently There is a critical need for nursing involvement at the beginning of any new technology or provision of patient care. Innovation flourishes in a shared governance environment in which nurses at the bedside provide input into nursing decisions and policies and procedures that govern their practice. Innovative partnerships with community-based organizations, professional organizations, and academic institutions are becoming the norm in many organizations. These innovative partnerships provide support and sharing of resources that benefit both groups and allows for best practice and long-lasting relationships. Innovation is essential to moving forward and is the foundation of our vision at UPMC Changing Medicine, Touching Lives, Defining Tomorrow. Granted Magnet status, UPMC St. Margaret continues to create an innovative environment to help shape the future of patient care and outcomes. UPMC St. Margaret encourages, supports, and recognizes new knowledge seekers, innovators, and improvement specialists and salutes their accomplishments. 3 Magnet Illuminations

4 NURSING RESEARCH FELLOWSHIP PROGRAM The Nursing Education, Research, and Evidence Based Practice Council at UPMC St. Margaret developed and sponsored the Nursing Care Success Innovators (NCSI) Nursing Research Fellowship Program. In September 2011, six research fellows were selected to participate in the new program to further nursing knowledge, discovery, and innovation. Currently, four of the six fellows continue their research, reflecting topics on patient satisfaction, nurse satisfaction, community health, and patient risk factors. During the first three sessions, the fellows were exposed to a crash course on research, including research design, patient safety, literature searching, and statistics. A primary focus of the research program is designing a study to be submitted to the University of Pittsburgh s Institutional Review Board (IRB). Once the studies are approved by the board, the fellows will be eligible to present and publish their research. Research will continue through Summer, with a new class of fellows expected to start in the Fall. For more information about the Nursing Research Fellowship Program, contact Amy Haugh, MLS, director, Health Sciences Library, at haughaj@upmc.edu. OUR RESEARCH FELLOWS AND THEIR STUDIES Expanded Family Visitation in the Postanesthesia Care Unit (PACU) Shawna Breghenti, RN, BSN, Perianesthesia Services, has been a nurse for five years. A graduate of the St. Margaret School of Nursing, and a student at Waynesburg University, Ms. Breghenti focuses her research on expanded family visitation in the Postanesthesia Care Unit (PACU) at UPMC St. Margaret. Through surveys and focus groups, she will gather feedback from unit nurses and information on the barriers to expanding family visitation at the hospital. Ms. Breghenti also will assess patient and family perceptions of the benefits of visitation. As a patientcentered initiative, the information gathered can be used to help involve families in patient care. Ms. Breghenti is using focus groups as an approach to collecting information rather than overwhelming staff nurses with more s and online surveys. She describes her fellowship experience in saying, The research fellowship is challenging, inspiring, and worth all the time and effort to reach set goals. Risk Factors for Pressure Ulcers in Total Hip and Knee Surgical Patients Angela Durci, RN, Unit 4B, has been a nurse for eight years. A graduate of Citizens School of Nursing, Ms. Durci is committed to reducing the number of pressure ulcers among orthopaedic patients who have had hip or knee arthroplasty. She is studying the prevalence of pressure ulcers with these patients and determining other risk factors that may lead to the development of pressure ulcers. Ms. Durci s research has been guided by her experience as a wound care nurse and working on the hospital s orthopaedic unit. By reducing the number of pressure ulcers, the study can help to reduce costs and improve patient care outcomes. Ms. Durci is close to submitting her research to the IRB. She says, The research experience has been a great learning opportunity. It can be a long process, involving many people at times, but I have had great support from my mentors, colleagues, and Nursing Education. Nursing research is very promising, and I hope to bring something positive to the nursing field and ultimately improve patient outcomes. 4 Magnet Illuminations

5 The Use of Sound Masking to Improve Patient Sleep and Daily Rest Michelle McClain, RN, Unit 5B, has been a nurse for two and a half years. A graduate of the St. Margaret School of Nursing, and a student at Edinboro University, Ms. McClain focuses her research on increasing patient satisfaction by reducing noise. Unique to the hospital environment, she is going to do a test using sound machines in patient rooms. The machine will allow patients to control background sounds, also known as white noise. If successful, the study may increase UPMC St. Margaret s Press Ganey Associates Inc. and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, as well as minimize the pressure on staff to work quietly while patients are sleeping. This is a patient-centered approach to increase sleep and comfort for patients, ultimately improving their health. Ms. McClain describes the benefits of the fellowship program in saying, This program has been a wonderful learning opportunity and I am proud of how much I have accomplished. I m confident that this program will not only help nurses to gain experience, but also to improve our practice for our patients. Effect of Nursing Education on Decreasing Smoking Prior to Physician Visits in An Outpatient Setting Michelle Regas, RN, Lawrenceville Family Health Center, has been a nurse for nine years. A graduate of the St. Margaret School of Nursing, Ms. Regas focuses her research on a nurse-driven intervention to decrease smoking in outpatients. Observing that many patients are smokers and may not receive attention to reduce their habit, she is studying the potential of setting the stage for the physician s discussion with the patient. Through a nursing interview and support, providing written patient education, and identifying interventions may raise physician awareness to address smoking during patient visits. Ms. Regas also is looking at follow-up interventions to be sure patients have the support they need to quit smoking. This project can provide nurses a heightened role in addressing a major public health concern and will likely result in improved health for patients. Ms. Regas describes her role in the fellowship in saying, Smoking is the leading, preventable cause of death. Continuing research in this area can have a positive effect on the community by providing a resource for information and a support system. I believe that patients will have a better smoking cessation or decreased smoking rate as a result. My research is focused at the UPMC St. Margaret Lawrenceville Family Health Center, but hopefully will expand to other community health centers. Nurse Mentors for the Program Ann Ciak, RN, PhD Bonnie Colaianne, RN, MSN, CNL, CIC Diane Corr, RN, BSN, MEd Susan DiNucci, RN, BSN, CIC Jolynn Gibson, RN, MSN, CDE Anna Kalafut, RN, MSN Laura Kling, RN, MSN, CNS, CPAN, CAPA Mary Beth Langdon, RN, MSN Janey Roach, RN, DNP Janine Sharer, RN, MSN Colleen Sunday, RN, MSN 5 Magnet Illuminations

6 NURSE LEADERS: CHERYL LENHART AND KAREN WEIMER Cheryl Lenhart, BSN, HRM, RN-BC, clinical director, Inpatient Nursing and Regulatory Compliance, has worked at UPMC St. Margaret since She has more than 35 years of diverse nursing experience, including progressive nursing management in inpatient and outpatient care, emergency care, critical care, and nursing research. Ms. Lenhart also has extensive public speaking experience. Her involvement in Magnet designation and redesignation efforts along with her advancement in professional nursing organizations provides UPMC St. Margaret with valuable expertise. Ms. Lenhart has been a key driver in several initiatives at UPMC St. Margaret, such as hospital throughput and nursing shared governance. Working with other nurse executives and members of the hospital s throughput teams, a Surge Response Plan was implemented in June The plan engages all hospital staff in preventing delays in patient placement and Emergency Department flow. In December 2010, Ms. Lenhart conducted a series of educational sessions on the concept of shared governance a basic premise of a Magnet organization. By working monthly with key Share Governance Council chairs and co-chairs, there is a fully functioning Nursing Division shared governance structure in place. This structure allows nurses at the bedside to actively participate in decision making, the representation of hospital and health system committees, and staff nurse leadership opportunities. Ms. Lenhart is a member of the American Nurses Association (ANA), Pennsylvania State Nurses Association (PSNA), Southwestern Pennsylvania Organization of Nurse Leaders, and the Leukemia and Lymphoma Society s Patient Education Committee. She lives in Greentree, PA, with her husband, Terry, and has two grown children, Erin and Matthew, who were both recently married. Ms. Lenhart enjoys traveling with her family and reading. Karen Weimer, RN, BSN, MSN, CRNP, lead nurse practitioner, has worked at UPMC St. Margaret since 1979, which then was known as St. Margaret Memorial Hospital. She started as a staff nurse on a medical-surgical unit, and later became the assistant patient care manager and then manager of the same unit. As a new graduate at the time, Ms. Weimer planned to work at the hospital for a year or so to gain experience in the nursing field, but after experiencing how devoted the medical and nursing staff are to their patients, she could not leave. Ms. Weimer graduated from the St. Margaret Memorial Hospital Louise Suydam McClintic School of Nursing, earned a bachelor s degree in nursing from Carlow University, a master s degree in nursing administration from La Roche College, and a post-master s certified registered nurse practitioner (CRNP) degree from Carlow University. Currently as UPMC St. Margaret s lead nurse practitioner, Ms. Weimer is responsible for nine nurse practitioner initiatives at the hospital. She says, We have a unique program in that nurse practitioners are unit-based and are available to staff and patients at all times of the day. Ms. Weimer is a member of the American Academy of Nurse Practitioners and the Pennsylvania Coalition of Nurse Practitioners. She received the Cameos of Caring Award in 2000 and The DAISY Award in Ms. Weimer resides in Moon Township, PA, with her husband, two rescue Chihuahuas, Chi-Chi and Tia, seven canaries, and one lovebird, Peachie. 6 Magnet Illuminations

7 NURSING EDUCATION, RESEARCH, AND EVIDENCE BASED PRACTICE COUNCIL Submitted by Rita Cook, RN, BSN, CMSRN, PCCN, Former Chair, and Ruth Harris, RN, BSN, ONC, Chair The Nursing Education, Research, and Evidence Based Practice Council was developed to provide the community with the most current, effective, quality nursing practice. By promoting research, using evidencebased practice, and participating in educational opportunities, the bedside nurse can be equipped to provide the highest standard of care, significantly impacting patient care outcomes. Congratulations to Jessica Lindenberger, the council s newly appointed co-chair. Education The council utilized staff surveys, conducted by Wendy Kastelic, Nursing Education, to determine barriers preventing bedside nurses from attending educational sessions. As a result, educational opportunities are frequently brought to nursing units (including off-shifts and weekends), programs are being shortened, and staff are prescheduled to attend sessions to ensure proper staffing levels for patient care coverage. Research The Nursing Care Success Innovators (NCSI) Nursing Research Fellowship Program was developed to assist bedside nurses in developing their ideas into research projects. Staff was encouraged to submit applications approved by their unit director, briefly stating their reason for wanting to participate. After a blinded review of 16 applicants, six individuals were selected of which four currently continue their research. Each research fellow receives eight hours per month of dedicated time to attend the program. Research classes are organized by Amy Haugh, director, Health Sciences Library, and projects are worked on with assigned nurse mentors. The Nursing Education, Research, and Evidence Based Practice Council organized the 2012 Clinical Research Forum, which was held May 18 in UPMC St. Margaret s James A. Ferrante, MD, Conference Center. This year s theme was Generating New Knowledge and Innovation Through Nurse-Driven Research. Participants who attended the entire session and completed an evaluation form were awarded a certificate and 4.7 contact hours. Evidence-Based Practice Knowing that ideas are often thought of, yet quickly forgotten at the bedside, Stacey Allen, advanced practice nurse, Rita Cook, Unit 3B, and Ms. Kastelic implemented the Ask-It campaign based on the article, Practical Steps for Evidence-Based Practice, by Bradi Granger, RN, PhD. Ask-It stands for: ask why, see what is in the literature, know that you can effect change, investigate improvement/best practice, and transform care at the bedside. Through the initiative, bedside nurses can post questions or ideas for improvements on the Ask-It board. The questions and ideas are discussed by the council and dispersed to the appropriate individual(s) for a followup response. Unit-based projects are intended to result from the proposed questions, with research and evidencebased solutions as the outcome. 7 Magnet Illuminations

8 THEATER IN THE ROUND AN INNOVATIVE EDUCATIONAL MODEL Submitted by Janine Sharer, RN, MSN As Pay for Performance programs designed to offer financial incentives to physicians and health care providers to meet defined quality, efficiency, or other targets evolves, acute care hospitals are challenged to bring about improvement in their patient satisfaction scores. It can be even more challenging for organizations to engage employees in exemplifying a culture of service. UPMC St. Margaret began to implement an initiative last year called Theater in the Round, through which hospital staff conduct 30-minute presentations that incorporate role playing related to Press Ganey Associates Inc. patient comments. Theater in the Round involves a theatrical setting with actors/ actresses, dim lights, stage crew, humor, and theater music. Employees are invited to attend the innovative educational series. The theater directors, Amy Haugh, director, Health Sciences Library, Cheryl Lenhart, clinical director, Inpatient Nursing and Regulatory Compliance, and Janine Sharer, advanced practice nurse, select the skits by going through the hospital s patient satisfaction comments and looking for trends or areas of concern that may need focused on. The comments are written out and divided into two scenes: scene one is the patient s perception of the experience that didn t necessarily have a positive outcome; and scene two enhances the same scenario to assist the employee in providing a positive patient experience. All skits include appropriate employee dress entire, integrations from the Acknowledge, Introduce, Duration, Explanation, and Thank You (AIDET) communication tool, and audience participation. At the end of all performances, the audience completes a ballot for best actor/actress for both a leading and supporting role. Once the votes are tallied, winners are presented with UPMC St. Margaret s version of the Academy Award. The Theater in the Round concept is a true Magnet moment in that both hospital leaders and bedside staff work as a team to improve patient outcomes. The innovative teaching method has been such a success that its directors have decided to expand the initiative to hospitalwide education programs. Some of the following are skits that have been performed: Some Other Way! In this scene, the performers roles provided multiple avenues for assisting employees to cope with the cognitively impaired, combative, and non-compliant patient. This skit had a collaborative approach between the nurse, patient, and the patient s family. The Power to Say Stop! In this scene, the performers role played Condition Stop, a hospital initiative through which doctors and nurses collaborate with the patient to ensure everything is correct and in place prior to performing a procedure (i.e. the consent being signed, the correct body part being initialed appropriately). 8 Magnet Illuminations

9 Stick It! Help Your Peers! This scene portrayed a patient experience with intravenous and lab draws feeling like pin cushions. To enhance the patient and employee experience, the performers role played policies and gave advice on how to create a more positive outcome. This scene was performed to assist nurses with the peer review process and to encourage them to discuss with each other wrong doings. The scenario portrayed a nurse texting while taking care of a patient. As another nurse walks by and witnesses the situation, he waits outside of the patient room to talk to the nurse about her inappropriate actions. Change My Sheets! In this scene, the performers role played the importance of cleanliness in patient rooms and in the hospital setting. Janine Sharer was selected to present UPMC St. Margaret s innovative educational model, Theater in the Round: Using Role Playing to Improve Patient Satisfaction Scores, at the 2012 ANCC National Magnet Conference, being held Oct. 10 through 12, at the Los Angeles Convention Center, California. The goal of the conference is to provide nurses and nursing executives from top hospitals the opportunity to enhance nursing professional practice in order to positively impact patient outcomes. Through structured education and networking events, the conference will focus on the needs of the adult learner and the use of the Magnet Model the framework of excellence in care delivery through innovation. 9 Magnet Illuminations

10 QUALITY: OPTIMAL DISCHARGE PLANNING PROGRAM Submitted by Marjorie Jacobs, RN, MSN, ACM, CPHQ On March 26, the Optimal Discharge Planning Program was implemented at UPMC St. Margaret. The program includes many aspects of Project Re-Engineered Discharge (RED), which was developed by a research team at Boston University Medical Center. The goal of Project RED is to implement strategies that improve the hospital discharge process to promote patient safety and reduce re-hospitalization rates. Components of RED: l Educate the patient about his or her diagnosis throughout the hospital stay. l Schedule appointments for physician follow-up and post-discharge testing. n Schedule appointments with input from the patient regarding the best time and date. n Coordinate appointments with physicians, testing, and other services. n Discuss reason for and importance of physician appointments. n Confirm that the patient knows where to go, has a plan about how to get to the appointment; review transportation options and other barriers to keeping these appointments. l Discuss with the patient any tests or studies that have been completed in the hospital and discuss who will be responsible for following-up with the results. l Organize post-discharge services. n Be sure the patient understands the importance of such services. n Schedule appointments that the patient can keep. n Discuss the details about how to receive each service. l Confirm the Medication Plan. n Reconcile the discharge medication regimen with those taken before the hospitalization. n Explain what medications to take, emphasizing any changes in the regimen. n Review each medication s purpose, how to take each medication correctly, and important side effects to watch out for. n Be sure the patient has a realistic plan about how to get the medications. l Reconcile the discharge plan with national guidelines and critical pathways. l Review the appropriate steps for what to do if a problem arises. n Instruct on a specific plan of how to contact the PCP (or coverage) by providing contact numbers for evenings and weekends. n Instruct on what constitutes an emergency and what to do in cases of emergency. l Expedite transmission of the Discharge Resume (summary) to the physicians (and visiting nurses) accepting responsibility for the patient s care after discharge that includes: n Reason for hospitalization with specific principal diagnosis. n Significant findings, such as laboratory and radiology findings. n Procedures performed and care, treatment, and services provided to the patient. n The patient s condition at discharge. 10 Magnet Illuminations

11 n A comprehensive and reconciled medication list, including allergies. n A list of acute medical issues, tests, and studies for which confirmed results are pending at the time of discharge and require follow-up. n Information regarding input from consultation services, including rehabilitation therapy. l Assess the degree of understanding by asking patients to explain in their own words the details of the plan. n May require removal of language and literacy barriers by utilizing professional interpreters. n May require contacting family members who will share in the care-giving responsibilities. l Give the patient a written discharge plan at the time of discharge that contains: n Reason for hospitalization. n Discharge medications, including what medications to take, how to take them, and how to obtain the medication. n Instructions on what to do if the patient s condition changes. n Coordination and planning for follow-up appointments that the patient can keep. n Coordination and planning for follow-up of tests and studies for which confirmed results are not available at the time of discharge. l Provide telephone reinforcement of the discharge plan and problem-solving two to three days after discharge. Information courtesy of Project RED UPMC St. Margaret s Discharge Advocate, Patty Jo Kelley, transitions coordinator for UPMC Health Plan, will help to put these various principles into action on a daily basis at the hospital for Health Plan medical inpatients. Ms. Kelley will follow patients throughout their hospital stay and partner with other disciplines to ensure them a smooth transition home. Outcomes that UPMC St. Margaret hopes to achieve include a decrease in 30-day readmission rates and an increase in follow-up activity with the patient s PCP. The initiative was launched at the hospital in April, taking place on Unit 3B. Additional nursing units will be added to the initiative in the next several weeks. Ms. Kelley focuses on the nursing admission and discharge process for patients. Areas of concentration include continuous education and reinforcement to patients on testing, medications, signs and symptoms of diagnosis, and physician follow-up. Ms. Kelley is working collaboratively with all staff, including physicians, nurses, Care Management, and other disciplines to ensure patients are provided the necessary information during and after their hospital stay. She follows patients after discharge through telephone calls, assuring that their needs have been met. A readmission task force, consisting of both UPMC Health Plan and hospital staff, will meet quarterly to review all 30-day readmissions for barriers and concerns. 11 Magnet Illuminations

12 SERVICE EXCELLENCE EMERGENCY SERVICES: BUILDING A STRONGER FOUNDATION FOR THE ULTIMATE PATIENT EXPERIENCE Submitted by Renée Carolan UPMC St. Margaret s Emergency Department (ED) is the window into its entire facility. The ED experience not only builds the foundation for the patient s admission, but is the determining factor of whether the patient or family will return to our hospital. Through great collaboration and dedication, there have been many improvements in the ED s quality and patient satisfaction measures. Below is a timeline of various initiatives and supportive measures that have been implemented over the past year, which have directly impacted positive ED results: April 2011 l Surge Response Plan was developed June through September 2011 l Surge Response Plan was implemented and incorporated into other departments for daily throughput (i.e. Environmental Services, Care Management) l Engaged a National Emergency Department Overcrowding Score (NEDOCS) response team to send NEDOCS alerts to department heads June 2011 l Acknowledge, Introduce, Duration, Explanation, and Thank You (AIDET) communication tool was launched July through September 2011 l Positive turnover in ED, new ED unit director position added, relationship building with ED physicians July 2011 through present l Clinical director, unit director, and clinicians dedicate increased visibility and support to staff with rounds and coverage October 2011 l ED Zoning Team, comprised of nursing staff, leadership, and physicians, began meeting to formulate new zoning initiative November 2011 l In-House Administrator (IHA) Program started; off-shift support, leadership visibility, and real-time service recovery March 2012 l ED Zoning began These initiatives have changed our patients ED experiences. Press Ganey Associates Inc. patient satisfaction surveys support this. As shown in the graphs featured in this article, survey scores have increased and stabilized. You will notice that before April 2011, there was a great deal of variability in results. Now the trends are steady, stable, and continuing to move upward. This speaks volumes for the work that has been done in the ED. Results shown in the graphs are for two categories: the overall ED mean score and waiting time to see the physician. Results are displayed by patient discharge dates. 12 Magnet Illuminations