Nurse-Driven Protocols for Abdominal Pain in the Emergency Department
Emergency department (ED) crowding hinders opportunity to deliver safe, quality patient care and detrimentally affects clinical outcomes. This process improvement initiative evaluated if an evidence-based facility approved nurse driven protocol (NDP) compared to no protocol affected length of stay (LOS), left without being seen (LWBS) rates over 10-weeks for non-pregnant adults with abdominal pain in a rural community ED. Emergency nurses were empowered to implement interventions improving throughput by decreasing patient presentation time to medical disposition. Pre/post implementation design found a clinically significant mean LOS reduction of 28-minutes. LWBS was reduced from 5.2 to 2.3 percent and found statistically significant.
Problem: Attempted to minimize emergency department patient throughput time and left without being seen rates for patients experiencing abdominal pain. Abdominal pain is common, accounting for seven to ten percent of all visits. Prolonged length of stay in abdominal pain patients is significant, given time to evaluate and intervene medically.
Measurement: Fishbone diagram to assess variables contributing to increased LOS; Data points of ED LOS, LWBS pre NDP implementation derived manually from ED medical records, provided to project lead by ED Nurse Manager. Data points post NDP implementation recorded by ED shift charge nurses on an internally created data collection tool.
Analysis: LOS was evaluated with means, standard deviation, and t-test for independent samples comparing differences in the dependent variable for the two independent groups. LWBS rates evaluated using two proportions z-test to examine if a significant difference existed between LWBS rates pre and post NDP implementation. P value <0.05 statistically significant.
Implementation: Implemented evidence based nurse protocol specific to abdominal pain, Obstacles included provider resistance in allowing nurse implementation. Re-education to providers given benefit of implementation in other settings reducing LOS, LWBS, an industry standard.
Results/Discussion: Pre and post implementation design resulted in clinically significant mean reduction of 28-minutes in LOS with NDP use. Overall LWBS reduced from 5.2 to 2.3 percent, statistically significant. Data collection tool found critical to success ensuring 100% subject capture for analysis. Results sustained with adoption of other ED NDPs
Speakers
Vice President Transformational Services - Alliant Management Services
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Patient Safety
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Location Virtual
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Organizer NAHQ Next
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