Monday, 18 November 2019
Overcrowding of the Emergency Department (ED) creates delays in care and puts patients at risk for adverse outcomes, along with decreasing patient satisfaction. It is estimated that ED visits will increase on average by 3.54% per year in the United States (Murphy et al., 2014). When inpatient beds are not available, many times patients are boarded in the ED, which lowers the quality of care and reduces the satisfaction of the patient ("Boarding," 2017). The purpose of this project was to examine the emotional response of nurses when receiving an admission and how that reaction affected patient throughput as well as patient satisfaction. Transitioning patients to inpatient units aligns with the Institute for Healthcare Improvement (IHI) Triple Aim, which recommends transforming care to improve the patient experience, improve the health of populations, and reduce costs (Roussel, Thomas, & Harris, 2016). Currently, the average time to move a patient out of the ED to an inpatient bed takes 60 minutes. Organizational goals have been set at 20 minutes. Decreases in patient satisfaction scores correlate to longer wait times in the ED. A 28 bed Neuro/Medical Surgical unit, with Ready to Move (RTM) to Occupied bed times averaging 63 minutes, was chosen to pilot the project. 100 nurses were interviewed on the emotional response to admissions with 98% verbalizing they have a negative reaction to admitting patients. Literature suggests that admissions are compared to code situations due to the lengthy time it takes the nurse away from their other patients (Mowinski Jennings, Sandelowski, & Higgins, 2013). Emotional Intelligence training has been shown to be beneficial in teaching adaptability and flexibility (Flowers, Thomas-Squance, Brainin-Rodriguez, & Yancey, 2014). 77 nurses were provided four hours of Emotional Intelligence (EI) training on how to identify triggers that cause emotional responses, such as admissions, and how to control the reactions. By using the complexity theory, education focused on decreasing emotional responses to non-emotional events to reduce variability in patient throughput. Nurses who were able to identify their emotional reaction to admissions and channel this into a positive response were able to pick up their patients in the 20 minute time frame. The nurses who still struggle with the emotional response are still taking on average 60 minutes. Press Ganey ED patient satisfaction scores have been consistently above 80% as the RTM to occupied times have decreased. Through enhanced awareness of emotions regarding patient throughput, patients will receive timely, high quality care to assure best outcomes.