IMPROVING OUTCOMES FOR PATIENTS ADMITTED THROUGH THE EMERGENCY DEPARTMENT: IMPLEMENTATION OF A STANDARDIZED REPORT PROCESS

Purpose: The purpose of this quality improvement (QI) project was to implement a standardized ED-to-inpatient RN handoff process that improved handoff and process flow, with a goal of decreasing Emergency Department length of stay for patients being admitted and admission wait time. Summary of the Evidence: The exchange of patient information is a necessary aspect of care across all healthcare settings. A critical component of this exchange is patient handoff. However, lack of standard work in the handoff process can lead to inefficient communication and delayed patient flow. Three themes emerged from a review of literature: 1) communication and its’ complexity, 2) tools used to improve communication, and 3) the use of QI methodologies for improving the handoff process. Description: Lean A3 methodology was used to address improvement, resulting in four key tools that were implemented: 1) ED to Inpatient Handoff Guideline, 2) Situation, Background, Assessment, Recommendation (SBAR) Communication Tool, 3) ED Charge Nurse Shadowing Guideline, and 4) Inpatient Charge Nurse Shadowing Guideline. Evaluation: Outcomes were measured using Analysis of Variances (ANOVA) for Emergency Department length of stay (LOS) and admission wait time for the months one year prior to implementation, one month before implementation, and two months of implementation of tools. In addition, ANOVA was used to compare patient transfer time and length of time to give/receive report pre versus post implementation of tools. Relevance: The ED LOS and admission wait time ANOVAs were not statistical different among the compared months (p>0.05). However, patient transfer time had a statistically decreased (p<0.05) time variables, going from 30.5 minutes (SD=18.2) pre-implementation to 24.2 (SD=8.8) and 21.7 minutes (SD=7.4) post-implementation. In addition, the length of time to give/receive report for ED admissions also had a statistically decreased (p