Stop the Chaos! One Patient at a Time, Please

Purpose:
Medical-surgical units frequently experience an influx of admissions from the emergency department (ED), a phenomenon known as batching. This means more than one patient arrives simultaneously on the unit, regardless of the unit's current situation.

Significance:
The driving forces are understood and valid: a need to move patients out of the ED and to improve the patient experience. A multidisciplinary team was formed to address this situation, as well as the dissatisfaction felt by medical-surgical nurses.

Strategy and Implementation:
A gap analysis of current process flow compared to the ideal state revealed delays in bed assignments; delayed and closed loop communication handoffs, jeopardizing patient safety; untimely transport requests; and, limited use by medical-surgical staff of an available electronic mechanism to prioritize bed assignments. A goal was set: Patient transport from documented time of admission in the ED through transport to assigned medical-surgical bed occurs within 50 minutes, inclusive of standard, required handoff communication. Countermeasures implemented included: mandatory use of the mechanism to prioritize bed assignments; handoff report from the ED nurse to the receiving registered nurse (RN) prior to transport; and, request for transport by receiving unit only after handoff report is secured.

Evaluation:
Quantitative outcomes include significant decreases in missed handoff communication and transport delays and a reduction in ED holds and ambulance diversions. Qualitatively, nurses report an improved sense of control over workload by prioritizing transfers.

Implications for Practice:
Staff throughout the care continuum relate improved relationships and teamwork. These strategies can be adapted within any organization to enhance ED throughput, staff and patient satisfaction, and patient safety.