Team Assist: Implementation of an Admission, Discharge, Transfer Team

Saturday, 28 October 2017

Minerva Gonzales, DNP
College of Nursing, University of Texas of the Permian Basin, Odessa, TX, USA
Carol Boswell, EdD, RN, CNE, ANEF, FAAN
School of Nursing, Texas Tech University Health Sciences Center, Odessa, TX, USA
Carey Rumbaugh, MSN
Nursing Education Department, Medical Center Hospital, Odessa, TX, USA

Patient care in an acute care facility is multifaceted and affected by many factors. Admissions, discharges, and transfers add an additional layer of complexity for nurses when multiple patients are admitted or discharged simultaneously. In addition to these episodic tasks, the complexity of the patient mix provides opportunities for the nurses to become overwhelmed with providing safe and competent care. It is of utmost importance to support nursing satisfaction in an effort to ensure safe, high quality care. Without proper support, periods of increased workload can lead to lower quality outcomes as well as nursing dissatisfaction. As quality and safety are continuously emphasized, it is vital nurses receive support during these periods of increased workload (Berkow, Vonderhaar, Stewart, Virkstis, & Terry, 2014). Particularly for bedside nurses, multiple admissions, discharges, transfers, and complex patient care add to the intricacy of nursing workload. These periods of increased workload, or situational workload, can lead to less than optimal patient outcomes as well as nursing dissatisfaction. Often times, even having a fully staffed unit does not meet the needs for situational workload. Patient turnover, which includes admissions and discharges, impacts workload as well as quality outcomes (Jennings, Sandelowski, & Higgins, 2013). Programs and processes need to be identified and tested to achieve optimal care for the acute care patients.

For a bedside nurse, admissions and discharges take a great deal of time to complete. When nurses become overwhelmed with multiple admissions and discharges, quality care can become more difficult to achieve. As nurses struggle to manage their time to care for all patients, resources must be provided to help ensure high quality care. According to Kelly, Runge, and Spencer (2015), high nursing workload contributes to nurses’ dissatisfaction leading to staff turnover. Nursing satisfaction could be increased while situational workload is decreased resulting in safe, high quality outcomes through the implementation of an admission/discharge/transfer (ADT) team.

Many organizations are faced with the difficulty of adding additional staff due to budget constraints. With this in mind, a 402 bed acute care hospital in West Texas initiated a “Team Assist” program. Clinical educators and directors would serve as ADT team members in an effort to use current staffing resources. Using Lewin’s Change Model, the team was initiated in September 2014. A combination of three educators and directors signed up each day to serve on the ADT team, with a requirement of once weekly participation to ensure adequate assistance was available. When the team was needed, the charge nurse would notify the operator and house supervisor who would then alert the team. The program has been in place for two years and continues to serve as a much needed resource.

This session will provide a dialogue concerning the challenges and opportunities encountered within the initiation and management of the "Team Assist" program. A discussion of the resources and evidence required for reaching the desired outcome will be presented so that participants can build on the experiences encountered.