Methods:
The study was conducted in a tetriary hospital with 1000 hospital beds with 3500 boarded patients per year. The intervention program included 4 stages:
Stage 1 – Recruitment of a task team which included the nursing administration such as the on-call nurse administrator, head nurses of the referring and hosting departments and the ED administrating staff. The team formulated the required criteria, mapped the boarded patients process, prepared a format for vital boarded patient information transfer as well as an information page for the boarded patient and his family.
Stage 2 – analysis of boarded patient process satisfaction amongst ED charge nurse and pilot deparment nurses. Analysis of level of knowledge on orthopedic boarded patient treatment amongst pilot department nurses.
Stage 3 – Instruction on boarded patient criteria for hospitalization for the ED charge nurse and instruction on orthopedic boarded patient treatment for the pilot department nurses.
Stage 4 – Re-examination of level of knowledge on orthopedic boarded patient treatment amongst pilot department nurses and re-examination of boarded patient process satisfaction in the pilot deparment and the ED.
Study measurements. A Likert scale satisfaction (1-5) questionnaire was designed and contained statements that represent attitudes toward the boarded patient process and level of satisfaction from the process. Furthermore, a Likert scale (1-5) knowledge questionnaire was designed regarding nursing care for common diagnoses of orthopedic boarded patients. The questionnaires were given to surgical nurse specialists and senior nurses for face validity. The validators were asked to state for each questionnaire whether all parameters were included and to express general opinion. The validators returned the questionnaire with a number of light adjustments in articulation which were applied.
Study sample. Convenience sample which included all hosting department nurses for boarding patients and ED charge nurse. 24 nurses in the hosting department and 10 ED charge nurses took part in the study with a 100% response rate.
Results:
Preliminary data was gathered during December 2017 in the thoracic surgery department and the ED. Data after criteria implementation was gathered during April 2018.
Level of knowledge amongst nursing staff for treating orthopedic patients in the pilot department has increased by 49%.
Level of satisfaction from communication and boarded patient process – A 32% increase in satisfaction was recorded for the boarded patient process amongst pilot department team and 23% amongst ED charge nurses. In general, a rise in all parameters was recorded except for the statement about arguments that exhibited a 16% decrease which indicates better communication between departments.
Process perception as a uniform standard – In the pilot department a 65% rise was noted in the perception on a uniform standard and clear process criteria. Similarly, amongst ED staff, which from the outset perceived itself as a user of clear criteria, a 23% rise was recorded in regard to clear criteria usage.
Complete information transfer – A 52% increase in satisfaction from information transfer was noted in the pilot department as part of team-to-team communication. As part of the perception of compliance with requests for boarded patients, a rise of 7% was recorded amongst thoracic team and 4% amongst ED charge nurses.
Conclusion:
Standardization of the boarded patient process, training of nursing staff and transmission of information to the patient were proven to increase satisfaction from the boarded patient process amongst nursing staff.
In conclusion, in light of the success of the intervention program in the pilot department, the program will be gradually expanded to all departments that host boarding patients.