• Int Emerg Nurs · May 2021

    A novel reflective practice intervention improves quality of care in the emergency department.

    • Mor Saban, Anat Drach-Zahavy, and Efrat Dagan.
    • The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. Electronic address: morsab1608@gmail.com.
    • Int Emerg Nurs. 2021 May 1; 56: 100977.

    IntroductionMost interventions to improve clinical outcomes in the emergency department (ED) are based on structural changes. This study embraced a different strategy and examined the impact of a reflective practice intervention (RPI) on ED quality of care.MethodsA pre-post-intervention quasi-experimental nested design was conducted between January 2017 and June 2018 in an Israeli public tertiary academic ED. Nighty-six ED teams (triage and staff nurses and a physician) were included pre and post RPI. Data were collected pre and post RPI at patient-triage nurse encounters using triage-accuracy questionnaires. Time to decision, length-of-stay, and hospitalization and mortality rates were retrieved from the medical charts of 1920 patients (20 per team).ResultsAccurate triage was significantly higher post than pre intervention (4.84 ± 1.45 vs. 3.87 ± 1.48; range 1-7; p < .001), whereas time to decision (253.30 ± 246.75 vs. 304.64 ± 249.14 min), hospitalization rates (n = 291, 30.3% vs. n = 374, 39.0%; p < .001), and hospital length-of-stay (5.73 ± 6.72 vs. 6.69 ± 6.20; p = .04) significantly decreased.ConclusionsBy adapting organizational reflective practice principles to the ED dynamic environment, the RPI was associated with a significant improvement in ED quality-of-care measures.Copyright © 2021 Elsevier Ltd. All rights reserved.

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