Journal of emergency nursing : JEN : official publication of the Emergency Department Nurses Association
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Efficiency and effectiveness are often used as quality indicators in emergency departments. With an aim to improve patient throughput and departmental efficiency while decreasing left-without-being-seen (LWBS) rates, this two-group, pre-intervention, post-intervention study in a pediatric emergency department evaluated the outcomes of implementing rapid triage on arrival-to-triage time, fast track utilization, and LWBS. ⋯ Although LWBS rates did not decrease with the intervention, implementation of a rapid triage system and fast track guidelines reduced arrival-to-triage times and decreased acuity in the LWBS population. Implementing rapid triage and fast track guidelines can affect nurse-sensitive patient outcomes related to safety and care delivery in a pediatric emergency department.
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Comparative Study
Perceptions of participating emergency nurses regarding an ED seasonal influenza vaccination program.
Numerous professional organizations have recommended that emergency departments provide influenza vaccine to patients. However, no study has reported on the perceptions of participating emergency nurses regarding ED influenza vaccination programs. ⋯ A majority of surveyed emergency nurses who had participated in an ED influenza vaccination program reported that the protocol was too time consuming and inappropriate for the ED setting. Surveyed emergency nurses expressed the opinion that such protocols required added staff, simplified patient consent/vaccination documentation requirements, and improved vaccine supply and stocking processes.
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"Time out for patient safety" is a simple and effective tool to improve communication among caregivers based on the use of critical language that has been effective in the perioperative setting, airline industry, and military. In the emergency department it is non threatening and focuses attention on safe patient care. "Time out for patient safety" complements the use of other standardized communication techniques such as SBAR in clinical situations in which immediate intervention is mandatory for patient safety. ⋯ The concept was well received by the group. Future research is needed to address outcomes for effectiveness.
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According to Drs Thom Mayer and Kirk Jensen, widely recognized experts in leadership, management, and customer service, "Improving patient flow essentially means patients spend exactly the right amount of time at every juncture in their journey through an organization, when you improve flow, you can serve more patients, with less effort and you can serve them better." 2 Recognizing that backups in the emergency department are a result of broken processes throughout the hospital is the first step in solving these problems. The most significant challenges are the prevailing attitudes that team triage and immediate bedding could not be done. Another challenge is the broad reaching nature of the issue. ⋯ As ED crowding worsens, it is important for departments to improve operations to promote patient throughput. No doubt, operational bottlenecks at the back end of the emergency department will ultimately lead to front-end delays. However, proficient patient processing at the ED front end can minimize the time to physician evaluation, increase patient satisfaction, and decrease totalED length of stay.