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Description
EBP
Practice Problem:
Long wait times in the emergency department (ED) waiting room significantly impact patient outcomes. Waiting times increase the risk of deterioration, the number of patients leaving without being seen (LWBS), and lead to dissatisfaction with care. 1,2,3 The urgency and significance of early recognition of abnormal vital signs and the appropriate responses cannot be overstated.3 Current ED practices lack a structured process for regular reassessment and escalation in the waiting room.
Literature/Evidence:
A comprehensive literature search was conducted, utilizing EBSCOhost, PubMed, and Ovid. The literature supports continuous reassessment to enhance safety and satisfaction in the waiting room.
Practice Change:
The new initiative aimed to improve the early recognition of deteriorating patients in the ED waiting room. This group developed a process that defined waiting room staff roles with reassessment guidelines, standard delegation orders, and the implementation of an escalation algorithm. In addition, an electronic communication tool was created.
Result:
Seven months of data were collected. Significant improvement was noticed in the frequency of reassessment. Full set of vital signs for patients waiting more than 2 hours rose from 10% to 81%. General assessments increased from 39% to 74%. Reassessments of vital signs at 3 hours or less from arrival to the waiting room rose from 46% to 93%. In contrast, the number of patients in the waiting room for more than 4 hours without a reassessment decreased from 15% to 0.6%. Of the patients with an acuity level change, 100% were recognized within the first 2.5 hours compared to the prior 27%. The percentage of patients LWBS decreased from 8.9% to 3.5%. The overall patient satisfaction increased from 61.9% to 72.8% during the pilot.
Conclusions:
The new process has demonstrated significant improvements in patient safety, a decrease in the number of patients LWBS, and increased patient satisfaction. This initiative cultivates cooperative work and proactive interventions between nurses and paramedics that enhance patient care and safety.
References
Burgess, L., Kynoch, K., & Hines, S. (2019). Implementing best practice into the emergency department triage process. International Journal of Evidence-Based Healthcare, 17(1), 27–35. https://doi.org/10.1097/xeb.0000000000000144
Innes, K., Jackson, D., Plummer, V., & Elliott, D. (2021). Exploration and model development for emergency department waiting room nurse role: Synthesis of a three-phase sequential mixed methods study. International Emergency Nursing, 59, 101075. https://doi.org/10.1016/j.ienj.2021.101075
Spechbach, H., Rochat, J., Gaspoz, J.-M., Lovis, C., & Ehrler, F. (2019). Patients' time perception in the waiting room of an ambulatory emergency unit: A cross-sectional study. BMC Emergency Medicine, 19(1). https://doi.org/10.1186/s12873-019-0254-1
Publication Date
9-27-2024
Keywords
EBP, Evidence-Based Pracitce, Evidence-Based Nursing, Emergency Nursing, Emergency Department, ED
Disciplines
Pediatric Nursing
Recommended Citation
Elizondo, Virginia; Caipo, Amanda; and Carlos, Cory, "Preventing Patient Deterioration by Creating a Reassessment and Escalation Process for the ED Waiting Room" (2024). 2024. 37.
https://scholarlycollection.childrens.com/nursing-anf2024/37
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
