TL11EO
Visibility, Accessibility, and Communication TL11EO
Using the required empirical outcomes (EO) presentation format, provide one example of an improved outcome where a clinical nurse(s) used data to advocate for the acquisition of a resource, in support of the care delivery system(s).
Example: Clinical Nurses Advocate for Resources to Improve the Emergency Department Throughput
Problem
The Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) emergency department (ED) patient discharged (DC) length of stay (LOS) was above target and negatively impacting hospital throughput.
Pre-Intervention
In November 2023, Jean Garland, BS, RHIA, Quality and Performance Improvement Coordinator, asked CHI SVHS ED leadership, including Renee Fechuch, MSN, RN, Clinical Director of Nursing, and Tanner Ross, BSN, RN, Nursing Manager, to collect data for Peter Wong, PhD, MS, MBA, RPh, Division Vice President, Performance Organizational Excellence, CommonSpirit Health (CSH), parent of CHI SVHS. Wong was scheduled to visit CHI SVHS in December 2023. The purpose of his visit was to address CHI SHVS challenges associated with patient throughput.
In November 2023, the CHI SVHS ED had a patient DC average LOS of 242 minutes, which was higher than expected and contributing to throughput challenges throughout the organization.
Goal Statement
Decrease the CHI SVHS ED patient DC average LOS.
Participants
ED Patient Discharge Work Group
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Name/Credentials |
Discipline |
Title/Role |
Department |
Renee Fechuch, MSN, RN |
Nurse |
Clinical Director of Nursing |
Nursing Administration |
Tanner Ross, BSN, RN |
Nurse |
Nurse Manager |
Emergency Department |
Peter Wong, PhD, MS, MBA, RPh |
Pharmacist |
Division Vice President, Performance Organizational Excellence |
CSH Administration |
Samalea Holt, RN |
Nurse |
Clinical Nurse, Patient Care Coordinator |
Emergency Department |
Andrew Terauchi, BSN, RN |
Nurse |
Clinical Nurse, Patient Care Coordinator |
Emergency Department |
Cayleb Meeks, RN |
Nurse |
Clinical Nurse, Patient Care Coordinator |
Emergency Department |
Carmelita Chavez, BSN, RN |
Nurse |
Clinical Nurse, Patient Care Coordinator |
Emergency Department |
Kayla Bullard, BSN, RN |
Nurse |
Clinical Nurse |
Emergency Department |
Anthony Blees, RN |
Nurse |
Clinical Nurse |
Emergency Department |
Description of the Intervention
December 2023
Early in December 2023, CHI SVHS ED leadership met with Wong. Wong's responsibility was to discuss throughput and identify areas of improvement not only in the ED but throughout CHI SVHS. Every department had a focus or aim statement for specific items with goals set to improve overall throughput. Decreasing the ED patient DC LOS was the CHI SVHS focus. Fechuch and Ross were responsible for this work.
Later in December 2023, during the CHI SVHS ED patient care coordinator (PCC) meeting, Ross collaborated with the clinical nurses or PCCs to discuss the new goal set forth by CSH, delivered by Wong. PCCs are ED charge nurses responsible for the flow of patients in the ED and are the individuals running the department daily.
Andrew Terauchi, RN, Clinical Nurse/PCC, shared the DC LOS ED data for the CHI SVHS ED patients with the PCC. The DC LOS data is monitored and collected daily. Ross discusses throughput data regularly, and the data is updated daily on the ED huddle board. Terauchi suggested adding a mid-shift RN to help with throughput and productivity. This recommendation was made based on throughput data, which illustrated peak ED volumes from 10 a.m. to 11 p.m.
Terauchi advocated for the acquisition of a mid-shift RN resource to Ross, stating that a way to decrease the CHI SVHS ED patients' DC LOS would be to add a mid-shift clinical nurse to the CHI SVHS ED daily staffing. Adding a clinical nurse would support the care delivery system by assisting with the influx of patients between the hours of 10 a.m. to 11 p.m., as these are the peak hours at CHI SVHS ED.
Carmelita Chavez, BSN, RN, Clinical Nurse/PCC; Samalea Holt, RN, Clinical Nurse/PCC; and Cayleb Meeks, RN, Clinical Nurse/PCC, agreed that this would help overall throughput and have a positive impact on decreasing the CHI SVHS ED patient DC LOS.
Ross brought Terauchi’s recommendation to Fechuch to see if they could work through the logistics of making this happen without adding an FTE. Fechuch and Ross collaborated and evaluated the current staffing for the department. Fechuch and Ross decided to move from a 7 a.m. to 7 p.m. clinical nurse position to an 11 a.m. to 11 p.m. clinical nurse position.
Ross collaborated in person with Kayla Bullard, BSN, RN Clinical Nurse, and Anthony Blees, RN, Clinical Nurse, during their ED shifts to see if they would be interested in making that switch. Bullard and Blees were on board and agreed this change would assist in obtaining the ED DC LOS goal.
January 2024
In the first week of January 2024, Bullard and Blees transitioned from their 7 a.m. to 7 p.m. shift to the 11 a.m. to 11 p.m. mid-shift. This allowed an additional clinical nurse to be on shift for most high-peak hours of the CHI SVHS ED.
The intervention was fully implemented by the end of January 2024.
CHI SVHS ED clinical nurse Terauchi used DC LOS and throughput data to advocate for a mid-shift RN FTE resource in support of the care delivery system. This advocacy resulted in improved throughput and decreased ED patient DC average LOS.
References
Di Marco, J. (2021, May). 17 Tips to Improve Patient Flow That Will Impact Efficiency. https://www.chthealthcare.com/blog/patient-flow
Umanailo, M. (2021). 2nd South American International Conference on Industrial Engineering and Operations Management. In ieomsociety.org. Publisher: IEOM Society International. Retrieved from https://doi.org/10.46254/SA02.20210969.
Outcome