Admission RN Pilot Tower 3 Angelica Ahonen RN, MSN, CMSRN Jaclyn Gallegos Ettenger RN, BS, MSN University of California Irvine Medical Center May 15, 2012 1
Problem: Situation on Tower 3 high demand for tele beds from the ED and housewide T3 receives average 7 admissions & 7 discharges per day (1/3 patient turnover) T3 staff voice increasing stress from admissions 2
Number of Bed Requests 200 180 160 140 120 100 80 60 40 20 0 Number of Bed Requests from ED Oct/Nov/Dec 2011 Tower 3 DH32 MICU1 DH78 T4 T3 Nursing Floor Oct-11 Nov-11 Dec-11 3
Number of Bed Requests 220 200 180 160 140 120 100 80 60 40 20 0 Number of Bed Requests from ED Jan/Feb/Mar 2012 Tower 3 DH 32 MICU DH78 T4 T3 Nursing Floor 12-Jan 12-Feb 12-Mar 4
Hypothesis Initiating the role of an Admission RN on T3 will decrease throughput time, increase the completeness and quality of the initial nursing admission assessment, increase nurse satisfaction, increase patient satisfaction, and decrease overtime 5
Method Designated one RN to fill role of the Admission RN for ~ 3 months Admission RN worked Mon, Tue & Fri from 2pm 2:30 am to match busiest ADT times Admit RN concentrated on ED admissions, discharges, and transfers 6
Results of Admit RN Pilot Throughput Admission Data Completeness RN Satisfaction Patient Satisfaction Overtime 7
80 Average Throughput from ED to Tower 3 Bed Assignment 70 60 65 60 60 60 Average Pre-Pilot: 62 min Time (min) 50 40 30 47 48 Average During Pilot: 52 min 20 10 0 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Month Pre-Pilot 27 Days Admit RN Worked 8
90 80 70 Average Throughput from ED to Tower 3 Actual Completion 69 82 73 Average Pre-Pilot: 75 min Time (min) 60 50 40 30 55 50 45 Average During Pilot: 50 min 20 Pre-Pilot 10 0 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Month 27 Days Admit RN Worked 9
Discussion of Throughput Results Regularly checks BMS for admissions and transfers Admit RN works close with PCC Beds are clean Helps move patients to accommodate ISO and Dialysis patients Helps notify RNs, SHAs & Tele Tech of new admits Proactive to receive report from ED 10
Admission Data Completeness Results 24 Chart audits: 12 Admit RN & 12 Non-Admit RN CHART CATEGORY ADMIT RN NON-ADMIT RN Height 100% 67% Weight 92% 67% Advance Directive 100% 83% PNA Vaccine Status 100% 58% Skin Assessment 100% 100% Medication Reconciliation 83% 17% Suicide Risk Assessment 100% 58% Supplemental Teaching 92% 42% 11
Admission Data Completeness Results Discussion Admit RN charts showed improvement in 7 of 8 categories Highlight: weight, PNA Vaccine Status, med reconciliation, and supplemental teaching Enhanced quality of the admission may help increase patient outcomes 12
RN Satisfaction Survey Results Survey: Likert Scale Covered 9 different aspects of the admission process on Tower 3 RNs given same survey before and after Pilot Number of Pre-Pilot Surveys: 31 Number of Post-Pilot Surveys: 29 13
Percentage of Nurses 100 90 80 70 60 50 40 30 20 10 0 40 35.7 52 32.1 SE1EOf, Admission Pilot Project Presentation to Throughput Committee-Conclusion.pdf I am satisfied with the admission process on Tower 3 21.4 4 4 10.7 Never Occasionally Often Always Nurses Responses Pre-Pilot Post-Pilot Shift towards more satisfied 14
Percentage of Nurses 100 90 80 70 60 50 40 30 20 10 0 Frequent admissions cause me to think about transferring to a different unit 9.7 6.9 34.5 22.6 22.6 44.8 45.2 13.8 Never Occasionally Often Always Nurse Responses Pre-Pilot Post-Pilot Shift towards less likely to transfer 15
Percentage of Nurses 100 90 80 70 60 50 40 30 20 10 0 Admissions contribute to the likelihood of me working overtime 6.5 7.1 12.9 35.7 32.3 25 48.4 32.1 Never Occasionally Often Always Nurse Responses Pre-Pilot Post-Pilot Shift towards less likely to work OT 16
Percentage of Nurses 100 90 80 70 60 50 40 30 20 10 0 Admissions decrease the level of safety of my nursing practice 24.1 16.1 16.1 31 35.5 24.1 32.3 20.7 Never Occasionally Often Always Nurse Responses Pre-Pilot Post-Pilot Shift towards an increase in safety 17
9.00 Nurse Average Satisfaction of Admission Process on Tower 3 Nurse Average Satisfaction Score (0-9) 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 0.00 Individual Nurse Responses Pre-Pilot Post-Pilot 18
Patient Satisfaction Results Tower 3 HCAPHS Scores: before and during Pilot HCAPHS Categories HCAPHS Scores Sep-Dec 2011 (46 respondents) HCAPHS Scores Jan-April 2012 (33 respondents) Nursing Communication 65.1 68.0 Pain Management 40.8 55.8 Overall Satisfaction 68.9 81.3 Qualitative data: Positive feedback from patients/family Positive feedback from those with multiple admissions 19
Overtime Results Pre-Pilot Overtime (9/30/11-12/13/11): Total OT: 1,949.5 hrs Total Admissions: 471 4.1 OT hrs/admission Pilot Overtime (1/27/12 4/13/12): Total OT: 1,404.1 hours Total Admissions: 564 2.5 OT hrs/admission 20
Discussion of OT Results Overtime hours used included RNs and SHAs Admit RN helps with vitals, tele & belongings list Significant reduction of 4.1 to 2.5 OT hrs/admission Not solely due to Admit RN Tower 5 tele opened 3/29/12 Other unknown factors When Admit RN on floor OT was reduced 21
Summary All results support the use of an Admission Nurse Improvements seen in: Patient throughput Quality of admissions RN Satisfaction Patient Satisfaction Staff Overtime Hope to improve patient outcomes through better quality care and education 22
Discover Teach Heal Discover: a solution to improve the admission process through research and action Teach: improved patient teaching and may be an example for other units Heal: opportunity to improve patient outcomes 23
Special Thanks!!! Susan Christensen Karen Grimley Eileen Polito Eric Belen Tower 3 Staff Throughput Committee 24
References Giangiulio, M., Aurilio, L., Baker, P., Brienza, B., Moss, E., & Twinem, N. (2008). Initiation and evaluation of an admission, discharge, transfer (ADT) nursing program in a pediatric setting. Issues in Comprehensive Pediatric Nursing, 31, 61-70. Hlipala, S. L., Meyer, K. A., Wallance, T. O., & Zaremba, J. A. (2005). Profile of an admission nurse. Nursing Management, 36(6), 44-47. Lane, B. S., Jackson, J., Odom, S. E., Cannella, K. A. S., & Hinshaw, L. (2009.). Nurse satisfaction and creation of an admission, discharge, and teaching nurse position. Journal of Nursing Care Quality, 24(2), 148-152. Morgan, R. (2007) Turning around the turn-arounds: improving ED throughput processes. Journal of Emergency Nursing, (33)6, 530-536. 25
References cont. Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia: Lippincott Williams & Wilkins. Spiva, L. & Johnson, D. (2012). Improving nursing satisfaction and quality through the creation of admission and discharge nurse team. Journal of Nursing Care Quality, 27(1), 89-93. Siehoff, A., Gancarz,67 B., & Wise, C. (2009) Improving patient admissions with dedicated admission nurses. Journal of Nursing Administration, 39(1), 11-13. 26
Example Survey I am satisfied with the admission process on 3 Tower Admissions affect the accuracy and/or completeness of my charting Admissions increase my work related stress Frequent admissions decrease my time at the patient s bedside Frequent admissions cause me to think about transferring to a different unit Admissions cause fragmentation of my ability to care for my patients Admissions contribute to the likelihood of me working overtime Admissions decrease the level of safety of my nursing practice The admission process helps establish a strong sense of teamwork Never Occasionally Often Always 27