Providing a Nurse Practitioner in Triage

Introduction

Chamberlain Hospital has been experiencing high volumes of surges, leading to higher than the national benchmark of Left Without Being Seen (LWBS) rates. The surge has led to lengthy wait times to see a provider, as well as declining patient satisfaction scores. The ED accounts for nearly all inpatient admissions and 35% of the hospital's surgical procedures. The average collection on each admission is $13,497.00, with an estimated loss of 372 patients left without being seen. This equates to an approximate loss of ,021,130.

00. By reducing the LWBS, Chamberlain Hospital will see up to $3,578,489.00 in revenue. The purpose of this paper is to discuss the project's scope, charter, and reveal implementation strategies that will be used in the project.

Project Scope

The scope of this project will be completed through the mission of Chamberlain Hospital, “To provide better care of the sick, investigate their problems, and further educate those who serve.” To carry out the organization's mission through this project, a PICOT question will be developed to address patients that left without being seen in Chamberlain Hospital’s Emergency Department. The PICOT question will specifically address the LWBS quality metric of the Chamberlain Emergency Department with an underlying focus on the department's culture. The PICOT question addressing this issue will be: “In adults ages 18-100 years of age admitted to the emergency department, does an assigned triage Nurse Practitioner decrease instances of 'left without being seen' compared to an assigned medic in an 8-week study?”

Using the 5W's and H, the project will be implemented using the five stages of Project Management. The project's aim will be to apply LWBS implementations in order to decrease LWBS by 2.6% or to reach the 2.0% LWBS national benchmark. To improve LWBS, an enhancement of patient flow within the ED is necessary. The improvement in patient flow through triage can be ultimately achieved by decreasing the amount of time patients spend in the ED (Richard & Jarvis, 2016). To directly address patient flow, a Nurse Practitioner will be assigned to the triage area instead of a medic. This strategy aims to decrease patient wait time and increase patient flow from triage to the exam rooms. Two FTE's will be allocated to this position to address surge times. Rapid assessments, labs, imaging, and other tests can all be completed after the speedy assessment of a patient in triage. This intervention will aim to maximize caregiver workflow, leading to faster, more efficient arrival-to-triage times, as well as quicker arrivals to the provider and bed. By placing a provider in triage, this project provides an advantage, enabling the provider to directly discharge from triage and/or the waiting room during times of surge (Knowles, Beltran, & Grover, 2020).

Project Charter

Providing a Nurse Practitioner in Triage will aim to decrease wait times, patients who leave without being seen, length of stay, admit length of stay, and overall length of stay. Implementation of nurse-initiated protocols can help initiate early diagnostic testing and improve patient throughput throughout the ED (Settelmeyer, 2018). The overall goal of the project is to decrease the rate of patients leaving without being seen by 2.6%, aiming to reach the national benchmark of a 2% rate. The project will start on May 4, 2020, and end on June 22, 2020, at Chamberlain Hospital's Emergency Department. As discussed in the scope of the project, the approach to this project will be to allocate a Nurse Practitioner to the triage area of the emergency department in order to rapidly assess, diagnose, and treat patients. Issues related to patients leaving without being seen will be reported by the charge nurse using vertical communication with the Nurse Manager of the unit. The Nurse Manager will report all barriers to the project to the Project Manager. Weekly meetings will take place with the task force assigned to address patients leaving without being seen, consisting of the ED Charge Nurse, Nurse Manager, Project Manager, and Director of Quality. Data pertinent to patients leaving without being seen will be discussed during the agenda of the meetings in order to identify trends and create a risk management/plan of action strategy if the project is not producing the expected results.

Conclusion.

In conclusion, Chamberlain Hospital’s Emergency Department has several issues impacting its core ED metrics. Due to surges and a high volume of ED admissions, Chamberlain Hospital’s LWBS rate is 4.6%, 2.6% higher than the national average of 2.0%. The goal of this project is to improve Chamberlain Hospital’s LWBS rate to the national benchmark of 2.0%. To reach this goal, interventions to maximize caregiver workflow and improvements to patient flow through the emergency department will be implemented. Cultural issues will be addressed on a case-by-case basis, including delayed discharges and incidents of incivility showcased in the scenario. A Nurse Manager’s enthusiasm for this project is essential to its success. Staff buy-in is crucial at all stages of the project and is greatly dependent on the unit culture (Herrera, 2016). Through the use of transformational leadership, fostering a positive work environment, and allocating 2.0 FTE’s to a triage Nurse Practitioner role, the project will aim to deliver better quality care as reflected in a decreased LWBS rate.

References

Knowles, K., Beltran, G., & Grover, L. (2020, May). Emergency department operations I: Emergency medical services and patient arrival. Emergency Medicine Clinics of North America, 38(2), 311-321. https://doi.org/10.1016/j.emc.2020.01.001
Richard, P., & Jarvis, E. (2016, June 30). Improving emergency department patient flow. Clinical and Experimental Emergency Medicine, 3(2), 63-68. https://doi.org/10.15441/ceem.16.127
Settelmeyer, D. (2018, May). Evaluation of an evidenced-based throat-pain protocol to reduce left-without-being-seen, length of stay, and antibiotic prescribing. Journal of Emergency Nursing, 44(3), 236-241. https://doi.org/10.1016/j.jen.2017.08.003

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