Two nurses at UConn Health in Farmington, Conn.—Kathleen Coyne, director of UConn's critical-care nursing, and Mary Laucks, the head of ED nursing—said that in 2011 the system faced a series of ED challenges. Clinicians and staff members were unhappy, staff turnover was high and patients waited well above national averages for care. And when patients waited for what they believed was emergent care, they showed their frustration with their feet.
“They're going to go to another hospital,” Coyne said. “We know that.”
The hospital re-evaluated its processes and decided to implement several small-scale, but significant, changes, Laucks said. Performance teams were formed to look at what, exactly, the ED was doing wrong and why its processes weren't working.
UConn Health discovered its initial triage and registration processes were inadequate. The system trained intake nurses to greet and quickly assess every patient who walked through the ED's doors, and clerical staff were added to help with backend registration. Perhaps most importantly, they said, communication increased between ED and inpatient nurses through biweekly meetings.
“This was one of the biggest successes in overcoming these hurdles,” Laucks said.
Several years ago the ED at HCA's Presbyterian/St. Luke's Medical Center in Denver, suffered from a “dry” culture and a lack of accountability, said Stephanie Wise, nursing director of its 23-bed ED. The hospital also went through a rough transition for its electronic health record.
Like UConn Health, Wise said it overhauled processes and, more importantly, the culture. Nurses rallied around a short, one-page philosophy called ICARE: integrity, compassion, accountability, respect and excellence. They worked with physicians to improve communication, even creating daily huddles so people knew what they were doing well at and what still needed improvement.
The straightforward changes have made Presbyterian/St. Luke's ED a better place for clinicians and patients alike, Wise said.
With healthcare reform emphasizing value-based care, especially on the inpatient side, more hospital nurses should take leadership to improve the ED setting, the speakers agreed. “We are all feeling the pressures of change,” Wise said.
Follow Bob Herman on Twitter: @MHbherman