PROJECT ADMIT Procedures to Enhance Treatment and Satisfaction

1
PROJECT ADMITProcedures to Enhance Treatment and
Satisfaction
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Susan Sherrill RN1, Shantae Hall RN1, Barbara
McClanahan2 ,EdD ,PhD. 1Lebonheur Childrens
Hospital, Memphis, TN. 2University of Memphis,
Memphis, TN

• BACKGROUND
• The pediatric emergency department has a history
  of delayed admission and treatment due to both
  emergent and non-emergent admissions being
  processed through the same locale. In an effort
  to reduce wait time and enhance overall patient
  care an interdisplinary team addressed the
  problem through the establishment and
  implemention of new admission policies and
  procedures aimed at enhancing patient care and
  experience. Changing existing practices which are
  deeply imbedded in a hospital culture is a
  significant challenge.

• RESULTS/OUTCOMES
• Wait time for direct admits reduced by
  approximately 75.
• ED patient load decreased allowing greater focus
  on higher acuity patients.
• Demand on floor staff decreased allowing
  increased attention to existing patients.
• Patient, staff, and physician report high
  satisfaction of new procedure.

• PATIENT Admit Process
• Private physician initiates procedure via phone
  to admit resident
• Alert resident and bed coordinator (admit nurse)
• Triage (admit) nurse greets patient and escorts
  to assigned room
• Introduction to surroundings and process by admit
  nurse
• Evaluation of patient (by nurse and assigned
  intern, resident)
• Necessary continuing care orders completed by
  nurse/resident
• Transition to inpatient status after hand-off
  report to assigned nursing staff complete.

• CHANGE STRATEGY STEPS
• Modify staffing for peak hours of 900am 900pm
  Monday Friday with on-call Saturday
• Secure small space for check-in and
  coordination
• Alert staff and private physicians of admit
  process
• Develop and distribute flyers with detailed
  procedures to all staff physicians via FAX and
  E-Mail
• Personally deliver brochures highlighting new
  procedures along with small incentives (cookies,
  etc. to enhance and maintain positive
  relationships with physicians and office staff).
• Staffing needs of Admit Unit
• Two Full-time RNs and one RN-PRN
• One Full-time EDT and one EDT-PRN

Interdisciplinary team consisting of key
stakeholders and gatekeepers was formed to
address the long wait times for new admissions.
(Chief of Medical Staff, Physician Liaison, Chief
Medical Resident, Directors of Nursing, Director
of Emergency Department, Emergency Department
Nurse, and Marketing Representative). Bi-monthly
meetings were held for six months to establish
overall plan and subsequent policies and
procedures .Multi-stage implementation plan
developed. Adherence to a participatory-based,
grass-roots approach was established and
maintained throughout the process ensuring
continuous communication at all levels.
PROCESS

• KEY LESSONS LEARNED
• Change is possible.
• Voices need to be heard and validated at all
  professional and participatory levels.
• Optimal solutions are generated by a
  multi-disciplinary approach.
• Changes were appreciated at all levels,
  particularly by chronic patients who require
  periodic and frequent admissions to the hospital.