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Congratulations to the selected Spotlight posters! These featured posters are the top 10 scored posters.
Updated: 03/22/23
Updated: 03/22/23
Objectives: Describe factors that inhibit endoscopy room productivity and list implementations to decrease room turn over time (TOT).
Background: Efficient room utilization and productivity are key in ensuring patient access, capacity, and revenue for ASCs. In 2021, from March to September, Apple Hill Surgical Center (AHSC) averaged 10 daily gastroenterology procedures per room using three endoscopy rooms. This rate of utilization was below target. While exploring possible variables affecting room utilization, the first noticeable factor was unreliable and inaccurate patient scheduling, as evidenced by lack of standard work. Critical variables including TOT, non-productive in-room time, individual provider or patient factors, and high patient reschedule/cancellation rates, were not considered when scheduling patients. There was a lack of prior data available to support the average case length. Also, no baseline metrics or process for in-room non-procedure work, and standards for room preparation were available.
Project description: In January 2022, an interdisciplinary team comprised of members from AHSC, digestive health, corporate lean advisors, schedulers, and system application analysts met to undertake a lean collaborative. Waste was identified and the team brainstormed ideas on countermeasures, which included tasks or changes categorized to either aid in implementing new and accurate provider scheduling templates or assist in creating lean processes and efficient standards for room TOT and non-procedural time.
Project goals: The goal of these countermeasures is to utilize AHSC’s endoscopy rooms to their full capacity corresponding with operational hours. When all three procedure rooms are operational for the duration of the day, each room will complete 15 procedures with nine in the morning and six in the afternoon. To meet this end goal, targets were put in place to keep the implementations on track. These targets were to be met by March 2022 and included improving daily utilization to average 15 daily procedures, reducing TOT from 14 minutes to 10 minutes and reducing in-room non-procedure time from nine minutes to five minutes per case.
Evaluation/results : In March 2022, the results were analyzed to determine if the project was on track. Daily utilization of rooms on average was 12.62 procedures, which was a 26% increase. The length of TOT decreased to 13 minutes, which shows a 7% improvement, and the in-room non-procedure time decreased to 8 minutes per case, indicating an 11% improvement. From this data, the team identified additional tasks to continue improvement to meet the facilities' full capacity and utilization goal. Results were again analyzed and reviewed on a monthly basis showing continued improvement.
Implications for nursing: Interdisciplinary collaborations are key in improving an ASC’s productivity. Nurses must assess and be aware of modifiable variables that impact TOT and ways to decrease waste in processes. Through open communication among physicians, advanced practice providers, anesthesiologists and nursing staff, along with other crucial personnel who impact endoscopy room utilization, these variables can be modified to improve patient access, capacity, and revenue.
Background: Efficient room utilization and productivity are key in ensuring patient access, capacity, and revenue for ASCs. In 2021, from March to September, Apple Hill Surgical Center (AHSC) averaged 10 daily gastroenterology procedures per room using three endoscopy rooms. This rate of utilization was below target. While exploring possible variables affecting room utilization, the first noticeable factor was unreliable and inaccurate patient scheduling, as evidenced by lack of standard work. Critical variables including TOT, non-productive in-room time, individual provider or patient factors, and high patient reschedule/cancellation rates, were not considered when scheduling patients. There was a lack of prior data available to support the average case length. Also, no baseline metrics or process for in-room non-procedure work, and standards for room preparation were available.
Project description: In January 2022, an interdisciplinary team comprised of members from AHSC, digestive health, corporate lean advisors, schedulers, and system application analysts met to undertake a lean collaborative. Waste was identified and the team brainstormed ideas on countermeasures, which included tasks or changes categorized to either aid in implementing new and accurate provider scheduling templates or assist in creating lean processes and efficient standards for room TOT and non-procedural time.
Project goals: The goal of these countermeasures is to utilize AHSC’s endoscopy rooms to their full capacity corresponding with operational hours. When all three procedure rooms are operational for the duration of the day, each room will complete 15 procedures with nine in the morning and six in the afternoon. To meet this end goal, targets were put in place to keep the implementations on track. These targets were to be met by March 2022 and included improving daily utilization to average 15 daily procedures, reducing TOT from 14 minutes to 10 minutes and reducing in-room non-procedure time from nine minutes to five minutes per case.
Evaluation/results : In March 2022, the results were analyzed to determine if the project was on track. Daily utilization of rooms on average was 12.62 procedures, which was a 26% increase. The length of TOT decreased to 13 minutes, which shows a 7% improvement, and the in-room non-procedure time decreased to 8 minutes per case, indicating an 11% improvement. From this data, the team identified additional tasks to continue improvement to meet the facilities' full capacity and utilization goal. Results were again analyzed and reviewed on a monthly basis showing continued improvement.
Implications for nursing: Interdisciplinary collaborations are key in improving an ASC’s productivity. Nurses must assess and be aware of modifiable variables that impact TOT and ways to decrease waste in processes. Through open communication among physicians, advanced practice providers, anesthesiologists and nursing staff, along with other crucial personnel who impact endoscopy room utilization, these variables can be modified to improve patient access, capacity, and revenue.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/22/23
Updated: 03/22/23
In 2010, The Institute of Medicine (IOM) published a report, The Future of Nursing: Leading Change, Advancing Health. This report outlined several recommendations that would allow for nurses to contribute to the improvement of patient outcomes and the healthcare system in general. One of the recommendations was that “nurses should practice to the full extent of their education,” meaning to work at the top of their license (TOL). In recent years, nurses have been tasked with providing more patient-centered, efficient, and cost-effective care. To meet these demands in a healthcare environment that consists of higher patient acuity and complexity, a nursing shortage, and significant fiscal constraints, nurses must be allowed to focus on tasks that require their unique knowledge and training.
Literature suggests that to achieve TOL practice, healthcare processes must be redesigned to identify tasks vital to nursing care and other activities that should be redistributed to nursing support staff. Summit Health provides coordinated care across urgent care, primary care, and multispecialty practices with more than 2,800 providers and 13,000 employees in over 370 locations in New Jersey, New York, Connecticut, Pennsylvania, and Oregon. The organization is expanding rapidly, requiring innovative approaches to delivering care and improving patient outcomes. This pilot’s purpose was to identify tasks that could be managed by support staff and enable registered nurses to work to the top of license.
The first initiative was to improve the management of medication prior authorizations. A unit was established to complete prior authorizations for the three service lines, reduce denials and appeals, and allow more time for the clinical team members to focus on provider support, interprofessional collaboration, care management, telephone triage, and patient education. The first step was to determine how many prior authorizations were being completed each month across the three service lines (1,200). We then assigned two support staff to focus completely on the prior authorizations and determined that one person could manage approximately 200 prior authorizations a month. We staffed a prior authorization unit with six people and did the following: 1)had each team member train in each individual service line; 2)created a standardized procedure for requesting prior authorizations, managing denials, and managing appeals; and 3) developed a pathway to route all prior authorization to that team in the EHR.
Over the past eleven months, authorization denials decreased by approximately 7%. Of those denials, only 0.25% required appeals. Urgent prior authorizations are completed in 72 hours and standard requests are completed in seven to ten days. Clinical time gained from this initiative is focused on quality improvement. The nurses are developing telephone triage protocols and collaborating with their clinical teams to create reference binders for new hires and the float team. Endocrinology nurses are developing a diabetes protocol to track patients who receive insulin dose adjustments. Most importantly, nurses have reported greater job satisfaction and patients are received their medications in a timelier manner. We received an innovation award for this initiative and have begun expanding this model to other service lines.
Literature suggests that to achieve TOL practice, healthcare processes must be redesigned to identify tasks vital to nursing care and other activities that should be redistributed to nursing support staff. Summit Health provides coordinated care across urgent care, primary care, and multispecialty practices with more than 2,800 providers and 13,000 employees in over 370 locations in New Jersey, New York, Connecticut, Pennsylvania, and Oregon. The organization is expanding rapidly, requiring innovative approaches to delivering care and improving patient outcomes. This pilot’s purpose was to identify tasks that could be managed by support staff and enable registered nurses to work to the top of license.
The first initiative was to improve the management of medication prior authorizations. A unit was established to complete prior authorizations for the three service lines, reduce denials and appeals, and allow more time for the clinical team members to focus on provider support, interprofessional collaboration, care management, telephone triage, and patient education. The first step was to determine how many prior authorizations were being completed each month across the three service lines (1,200). We then assigned two support staff to focus completely on the prior authorizations and determined that one person could manage approximately 200 prior authorizations a month. We staffed a prior authorization unit with six people and did the following: 1)had each team member train in each individual service line; 2)created a standardized procedure for requesting prior authorizations, managing denials, and managing appeals; and 3) developed a pathway to route all prior authorization to that team in the EHR.
Over the past eleven months, authorization denials decreased by approximately 7%. Of those denials, only 0.25% required appeals. Urgent prior authorizations are completed in 72 hours and standard requests are completed in seven to ten days. Clinical time gained from this initiative is focused on quality improvement. The nurses are developing telephone triage protocols and collaborating with their clinical teams to create reference binders for new hires and the float team. Endocrinology nurses are developing a diabetes protocol to track patients who receive insulin dose adjustments. Most importantly, nurses have reported greater job satisfaction and patients are received their medications in a timelier manner. We received an innovation award for this initiative and have begun expanding this model to other service lines.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/14/23
Updated: 03/14/23
Matching staffing to workload is crucial to efficient operations. At a major academic medical center, the journey to optimize staffing in the ambulatory care setting began in 2017 with a workgroup of administrators and analysts to develop a system to accurately track staffing. Focusing in on nurses and medical assistants (MA), the workgroup electronic medical record (EMR) for patient messaging by ambulatory care contracted full-time equivalent (cFTE) nurse visits, nurse/MA-assisted procedures, patient per sessions, and forms encounters. This data was then compiled in a spreadsheet format.
The spreadsheet was rolled out to the clinics by geographical area in 2018. Each clinic was provided with a customizable staffing workload too kit to begin the process. A limitation of the early tool was the labor-intensive manual input of the data. In 2020, the spreadsheet was move from Excel to data visualization tool Power BI to allow results to automatically populate in a standardized model. Clinic specific models, such as an infusion specific model, were added as well as a rooming stetting feature. This tool became a step in the position request process.
A 2021 update added improved formatting, the ability to specify roles for activities, and the optional projected adjustment of cFTEs and/or visit encounter. The most up-to-date version implemented in 2022 allows greater customization. Clinics may upload outside images or specify the max daily average number of nurses needed to support operations. A page was added detailing historical encounter responsibility and another to list the calculated ambulatory care cFTE and available hours of providers for each clinic. It features a seven-step process to complete the tool, with data sourced from the EMR in three-month increments. Each panel allows users to enter data on expected workflows or utilize existing EMR data. After completion of the seven panels, users can select to complete the calculation, leading to a summary page. This summary page is based on input from seven panels which provides users with the estimated historical and projected FTE to estimate volume of needed cFTEs. This page provides a table below the projections with an actual FTE for the selected clinic for each role. By utilizing this model, the estimated and actual staffing needs become more aligned. New pages summarize breakdowns of each captured activity. A percentage is assigned to the role completing the work. For the RN workload, the percentage is 1 RN/LVN per 4 cFTE providers. The final page shows historical data by role. Users can hover over each of those activities and see all percentages together with the daily average volume for each activity.
In the 90-day date range from January 7, to April 5, 2022, the tool was viewed 453 times by 54 unique viewers. The view rank is 51/7,394. This rank shows the relative popularity of the report in comparison to other PowerBi reports in the organization that had a least one view in the 90-day period, illustrating the usefulness of the tool for a wide range of users.
The spreadsheet was rolled out to the clinics by geographical area in 2018. Each clinic was provided with a customizable staffing workload too kit to begin the process. A limitation of the early tool was the labor-intensive manual input of the data. In 2020, the spreadsheet was move from Excel to data visualization tool Power BI to allow results to automatically populate in a standardized model. Clinic specific models, such as an infusion specific model, were added as well as a rooming stetting feature. This tool became a step in the position request process.
A 2021 update added improved formatting, the ability to specify roles for activities, and the optional projected adjustment of cFTEs and/or visit encounter. The most up-to-date version implemented in 2022 allows greater customization. Clinics may upload outside images or specify the max daily average number of nurses needed to support operations. A page was added detailing historical encounter responsibility and another to list the calculated ambulatory care cFTE and available hours of providers for each clinic. It features a seven-step process to complete the tool, with data sourced from the EMR in three-month increments. Each panel allows users to enter data on expected workflows or utilize existing EMR data. After completion of the seven panels, users can select to complete the calculation, leading to a summary page. This summary page is based on input from seven panels which provides users with the estimated historical and projected FTE to estimate volume of needed cFTEs. This page provides a table below the projections with an actual FTE for the selected clinic for each role. By utilizing this model, the estimated and actual staffing needs become more aligned. New pages summarize breakdowns of each captured activity. A percentage is assigned to the role completing the work. For the RN workload, the percentage is 1 RN/LVN per 4 cFTE providers. The final page shows historical data by role. Users can hover over each of those activities and see all percentages together with the daily average volume for each activity.
In the 90-day date range from January 7, to April 5, 2022, the tool was viewed 453 times by 54 unique viewers. The view rank is 51/7,394. This rank shows the relative popularity of the report in comparison to other PowerBi reports in the organization that had a least one view in the 90-day period, illustrating the usefulness of the tool for a wide range of users.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Tags:
gestational diabetes mellitus
glucose tolerance testing
postpartum care
patient reminders
prediabetes
Updated: 03/22/23
Updated: 03/22/23
Background: According to the CDC, every year 2-10% of pregnancies are affected by gestational diabetes. Groups such as ACOG (American College of Obstetrics & Gynecology) and ADA (American Diabetes Association) recommend assessing for persisting diabetes or prediabetes 4-12 weeks post-partum. It is estimated that 50% of women with GDM will develop diabetes later in life and less than 50% of women complete the recommended postpartum glucose testing (Martinez, Niznik, Yee 2017). GDM often resolves after delivery with up to 33% of women having a continuum of prediabetes or diabetes at their postpartum visit (Killion 2018). Purpose: To develop a sustainable workflow that will increase providers placing orders for two-hour glucose tolerance testing and increase patient completion rate of testing in postpartum patients to evaluate for the progression of type 2 diabetes. Description: The maternal fetal medicine clinic team began working to strengthen workflows focused on patients with GDM when an opportunity was identified in the care of the postpartum patient. Upon further evaluation, a gap was identified in providers placing two-hour GTT orders and patients completing the testing. After completing a baseline gap analysis, our team began utilizing process mapping and report out tools to develop a workflow to increase the completion rate of postpartum screening for diabetes. Evaluation/outcome: Utilizing EMR tools, patient education, and patient reminders to ensure completion of diabetes screening, the maternal fetal medicine clinic was able to increase screening from 26% up to 60%. Early diagnosis and treatment of prediabetes or type 2 diabetes can improve patient outcomes such as having well controlled A1cs and connecting patients to resources for lifestyle changes allowing for earlier interventions and improved patient outcomes.
References 1) Martinez NG, Niznik CM, Yee LM. Optimizing postpartum care for the patient with gestational diabetes mellitus. Am J Obstet Gynecol. 2017 Sep;217(3):314-321. doi: 10.1016/j.ajog.2017.04.033. Epub 2017 Apr 26. PMID: 28455081; PMCID: PMC5581263.
2) American Diabetes Association; 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2021. Diabetes Care 1 January 2021; 44 (Supplement_1): S200–S210. https://doi.org/10.2337/dc21-S014
3) Killion, Molly M. MS, RN, CNS. Managing Gestational Diabetes Postpartum. MCN, The American Journal of Maternal/Child Nursing: July/August 2018 - Volume 43 - Issue 4 - p 231 doi: 10.1097/NMC.0000000000000444
References 1) Martinez NG, Niznik CM, Yee LM. Optimizing postpartum care for the patient with gestational diabetes mellitus. Am J Obstet Gynecol. 2017 Sep;217(3):314-321. doi: 10.1016/j.ajog.2017.04.033. Epub 2017 Apr 26. PMID: 28455081; PMCID: PMC5581263.
2) American Diabetes Association; 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2021. Diabetes Care 1 January 2021; 44 (Supplement_1): S200–S210. https://doi.org/10.2337/dc21-S014
3) Killion, Molly M. MS, RN, CNS. Managing Gestational Diabetes Postpartum. MCN, The American Journal of Maternal/Child Nursing: July/August 2018 - Volume 43 - Issue 4 - p 231 doi: 10.1097/NMC.0000000000000444
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/22/23
Updated: 03/22/23
The continuous glucose monitor (CGM) is a powerful tool to engage patients and health care providers to successfully manage type II diabetes. The purpose of the study was to increase engagement and improve outcomes in patients with T2 diabetes in a family practice setting. This clinical design using continuous glucose monitors has improved quality measures, reduced hypoglycemic events, and increased patient engagement. It has also benefited the physicians, as they are better equipped to make data driven adjustments to patients’ medications and life style practices.
Our CGM project has been a collaboration among the physicians, chronic disease care manager nurse, the clinic supervisor RN, and the supply vendor. The goal was to enroll patients who were on at least one injection (insulin or GLP1), not to HbA1C goal, a newly diagnosed T2 diabetes patient, or a patient having hypoglycemic events. We have initially placed 70 CGMS to date and enrolled 35 patients in our study. The patient’s glucose levels were tracked through an online program which shows time in range, average glucoses, GMI (glucose management indicator similar to HbA1C), and average low glucose events per day. Patient satisfaction surveys were collected and pre-HbA1Cs were also compared to their 90 day HbA1c. The physician’s workflow was to identify the patient, manage medication adjustments, and submit billing codes. The RNs created a workflow for applying the sensor, ordering supplies, educating the patient, and evaluating the outcomes.
Our outcomes data included a reduction of HbA1C of 1.6%, improvement in time in range, a decrease in time above and below range, and a reduction of hypoglycemic events. The patients’ average glucose at the beginning of the study was 162 and at the end of 90 days was 142. The patient satisfaction surveys indicated that patients’ awareness of glucose levels increased to 4.8 out of 5 and the impact of changing their nutrition was 4.5 out of 5. Patients indicated they had improve dietary choices, increased their knowledge, and enjoyed the ease of use of the CGM. Our goal is to implement this practice in all primary care facilities in the Kootenai Health System and influence other organizations to adapt CGM use for T2 diabetic patients.
Our CGM project has been a collaboration among the physicians, chronic disease care manager nurse, the clinic supervisor RN, and the supply vendor. The goal was to enroll patients who were on at least one injection (insulin or GLP1), not to HbA1C goal, a newly diagnosed T2 diabetes patient, or a patient having hypoglycemic events. We have initially placed 70 CGMS to date and enrolled 35 patients in our study. The patient’s glucose levels were tracked through an online program which shows time in range, average glucoses, GMI (glucose management indicator similar to HbA1C), and average low glucose events per day. Patient satisfaction surveys were collected and pre-HbA1Cs were also compared to their 90 day HbA1c. The physician’s workflow was to identify the patient, manage medication adjustments, and submit billing codes. The RNs created a workflow for applying the sensor, ordering supplies, educating the patient, and evaluating the outcomes.
Our outcomes data included a reduction of HbA1C of 1.6%, improvement in time in range, a decrease in time above and below range, and a reduction of hypoglycemic events. The patients’ average glucose at the beginning of the study was 162 and at the end of 90 days was 142. The patient satisfaction surveys indicated that patients’ awareness of glucose levels increased to 4.8 out of 5 and the impact of changing their nutrition was 4.5 out of 5. Patients indicated they had improve dietary choices, increased their knowledge, and enjoyed the ease of use of the CGM. Our goal is to implement this practice in all primary care facilities in the Kootenai Health System and influence other organizations to adapt CGM use for T2 diabetic patients.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Christina Madriz, MBA, MSN, RN, CENP, Change Management Leader, IU Health Physicians
Updated: 03/14/23
Patients within a large midwestern multi-site ambulatory primary care practice group are connecting with their healthcare providers and the ambulatory patient care team at record-breaking levels outside of the traditional provider appointment visit. The department’s 2022 forecasted clinical message volume consisting of symptom-based telephone triage calls, patient portal messages, and prescription renewal messages is forecasted to double from the 2019 volume, which will result in nearly 2 million clinical messages being received by the department. Unfortunately, this large burden of “asynchronous” (Moyer, 2018, p. 277) work has historically been difficult to quantify, leading to a lack of a staffing model and patient safety concerns due to inefficient workflows and delays in care.
This poster presentation describes how nursing leaders worked closely with internal and external subject matter experts and stakeholders to develop a report that provides visualization and quantification of the asynchronous work of ambulatory care nurses and the ambulatory patient care team. Examples of the capabilities of the report include the total number of unique departmental clinical inboxes, the number of clinical messages received within a specific inbox per day and per month, and the number of messages the nurse completes per day and per month. Furthermore, learners will discover how the organization is utilizing the report’s capabilities to develop data-driven strategies and staffing models to deliver care effectively and safely to patients.
In its 2017 position paper, the American Academy of Ambulatory Care Nursing (AAACN) discussed “technology-enhanced practice” asserting that “nurses must demonstrate core informatics and computer skill competencies” (p. 3). It is imperative that nursing leaders have awareness and visualization of all patient care needs in the ambulatory care environment to ensure that patients are being cared for safely and effectively.
References
1) American Academy of Ambulatory Care Nursing. (2017). American Academy of Ambulatory Care Nursing position paper: The role of the registered nurse in ambulatory care. Nursing economic$, 35(1), 39-47.
2) Moyer, A. (2018). A quality improvement project for understanding work-based need in ambulatory care. Nursing Economics, 36(6), 276.
This poster presentation describes how nursing leaders worked closely with internal and external subject matter experts and stakeholders to develop a report that provides visualization and quantification of the asynchronous work of ambulatory care nurses and the ambulatory patient care team. Examples of the capabilities of the report include the total number of unique departmental clinical inboxes, the number of clinical messages received within a specific inbox per day and per month, and the number of messages the nurse completes per day and per month. Furthermore, learners will discover how the organization is utilizing the report’s capabilities to develop data-driven strategies and staffing models to deliver care effectively and safely to patients.
In its 2017 position paper, the American Academy of Ambulatory Care Nursing (AAACN) discussed “technology-enhanced practice” asserting that “nurses must demonstrate core informatics and computer skill competencies” (p. 3). It is imperative that nursing leaders have awareness and visualization of all patient care needs in the ambulatory care environment to ensure that patients are being cared for safely and effectively.
References
1) American Academy of Ambulatory Care Nursing. (2017). American Academy of Ambulatory Care Nursing position paper: The role of the registered nurse in ambulatory care. Nursing economic$, 35(1), 39-47.
2) Moyer, A. (2018). A quality improvement project for understanding work-based need in ambulatory care. Nursing Economics, 36(6), 276.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Tags:
teamwork
value-based care
preventable acute care admissions
decreasing hospital capacity
nurses working at the top of their scope
Updated: 03/30/23
Updated: 03/30/23
Nurse initiative: In essence, the science of oncology has outpaced the healthcare system and the conventional delivery of care. While patients are living longer than ever before, innumerable days are spent suffering with uncontrolled symptoms or receiving acute treatment in emergency departments and inpatient hospitals, adding emotional, financial, and personal burden to patients and their families. This gap between conventional cancer care models and the progression of cancer science has necessitated the creation of new and innovative care delivery models aimed at improving the value, experience, and delivery of oncology care. Implementation strategies: In response to this need, a multidisciplinary urgent care was developed to provide urgent care services and advanced symptom management tailored to the unique need of oncology patients. Directed by a nurse practitioner and led by nurses practicing at the top of scope, the clinic utilizes a collaborative model of hospitalist and oncology trained advanced practice providers, in partnership with acute-care and oncology trained RNs, to provide a high-quality, cost-effective, patient-centered alternative to the emergency department. Evaluation of the impact/effectiveness of the organization: Since 2019, the CARE clinic has reduced rate of 30-day preventable ED visits by nearly 50%, and volumes have expanded rapidly, with a >40% increase in year-over-year volume in the last 2 years. Approximately 40% of patients report that the would have sought care in the ED if the CARE clinic had not been available, and over 99% of patients rate their visit as "excellent" or "good." Implications for nurse practice: The healthcare system is rapidly changing. Rising costs, capacity issues, and increased emphasis on patient experience necessitates innovation and change, and our clinic has led the way. The model has gained national attention, with numerous organizations seeking to replicate and implement similar models within their own institutions. In addition to the oncology patient population, this model has opportunity to expand to other high-utilizing complex patient care populations, including transplant, heart failure, COPD, and so many more.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 06/20/23
| Purpose: Within our ambulatory primary care clinics, planning for the ever-changing needs of our patients and communities is a priority of leadership and clinical education. Ambulatory care telephone triage is one of the organization's most rapidly growing and changing specialties. Our goal was to improve and expand telephone triage nurse knowledge through the implementation of a standardized triage core class for new and experienced triage nurses. This program would be the replacement for a multitude of individual processes that existed among the over 50 ambulatory primary care practices. Description: A literature review of evidence related to telephone triage nurses was conducted using the search terms “primary care triage,” “triage education,” and “telephone triage.” Based on these findings, a proposal was developed for a standardized triage nurse-training program. In November 2021, the triage core class was launched. Working with our ambulatory care and triage leadership, priority attendees were identified and an ongoing attendance schedule was established. This program promoted standardized, evidence-based education for all primary care telephone triage nurses and allowed them to enhance their skills, knowledge, and understanding of the significance that their role had on patient safety and satisfaction. The triage core class was initially rolled out as a 2.5-day in-person, biweekly class. Due to a number of COVID surges and creative hiring strategies, the class was converted to a 2-day virtual, biweekly class. Evaluation and outcome: Each attendee completed a pre-class “knowledge check” that surveyed their self-reported ability to demonstrate various tasks and skills critical to their ambulatory care telephone triage role. At the conclusion of class, attendees were notified that they would receive a post-class “knowledge check” with the same questions in the weeks following. This would provide their self-assessment after having an opportunity to apply and utilize the information learned in class. 81% of attendees responded to the post-class “knowledge check”. Responses to each of the 14 knowledge questions demonstrated an increase in the number of triage nurses who felt that they were able to demonstrate each item without assistance (between 10 to 39% increase). Additionally, triage core class attendees rated themselves using Benner’s novice to expert scale, with 53% of all new and experienced triage nurses rating themselves as competent to expert. This program provided an opportunity to close identified educational gaps, standardize the information shared with our triage nurses, identify future educational needs and opportunities, and facilitate the delivery of high-quality patient care in a telehealth setting. It also created an opportunity for resourceful education for staff spread amongst a wide geographical area, including those that work remotely. |
Updated: 06/26/23
| We all know the effects of the pandemic. The PACT (patient-aligned care team) model for patient care became “diseased.” Accessing care became limited due to CDC (Centers for Disease Control) workplace guidance and recommendations. Staffing was severely affected by shortages as PACT nurses left, exercised early retirement, or were reassigned to support the inpatient hospital resulting in PACT’s scrambling for coverage. This went on for 2 years. The outpatient CNL (clinical nurse leader) recognized the departure from the PACT model to address the needs of the patient caused by the pandemic defaulted to the team nursing model being utilized. Our CNL proactively conducted a “pulse check” with the results of this cohort survey showing the biggest challenges to using the PACT model included shortfalls to the scheduling, staffing, PACT panel size, unclear roles of staff, workload expectations perceived as unrealistic, lack of teamwork, and ineffective communication. Primary care and nursing administration responded to the results of the survey and conceptualized the development of a PACT hub of excellence aimed to improve the knowledge of staff on resuming the use of the PACT model. PHE started as a 120-day detail to create a process improvement and sustainment program for excellence in primary care. The goal is to provide one primary care subject matter expert at each of the major primary care clinics to act as the coach/educator for PACT. A curriculum for training was developed and named the PACT reboot to re-educate and reinvigorate PACT team members to use the PACT model for patient care. Training began in February and extended into August 2022; 22 classes were held, and 56 PACTs were trained, with a total of 314 PACT members attending the training in total. Longitudinal cohort surveys conducted showed 86% of the responding attendees were satisfied with the knowledge gained and felt they achieved the desired learning outcomes for the training. HEDIS (Healthcare Effectiveness Data and Information Set) performance measures for diabetes and Ischemic heart disease associated with the attending PACTs were reviewed by facility and comparing the PACT clinical performance scores pre- and post-training. The results reviewed reflected an improvement in the management related to chronic care. Reflecting this success, the PHE program was made permanent, and staffing was enhanced. Currently, a provider and additional nursing coach have been added to the program. PHE coaching of the PACTs in each clinic remains ongoing. A new employee “bootcamp” 5-day training has been developed to train new PACT employees on PACT processes. Information on the PHE presentations, training techniques, and the success of the program are shared with other PACT educators within the system network. |
Updated: 06/26/23
| Purpose of project: To promote joy at work for clinical nursing staff and explore the impact of appreciative inquiry (AI) techniques approaches on satisfaction and engagement by applying evidence-based practice. Methodology: A mixed method design was used in ambulatory care clinical settings. Data were collected using Pulse surveys, three open-ended feedback questions, and the NDNQI annual employee engagement survey (EES) in 2020 and 2021. Descriptive statistics and a paired t-test were analyzed; in addition, excerpted comments from the feedback answers supported the data of AI workshops impact. Results: Although results did not indicate statistical significance from the paired t-test, the AI workshops impacted non-RN staff significantly. All participants indicated that the AI workshops were helpful in increasing their joy at work. 50% of participants answered that AI workshops generated positive energy in the team, and they felt more joy at work, although the other half indicated not measurable increase of joy at work due to lost members. The 2021 engagement indicator (3.62 out of a 5-point scale) in the clinic showed slightly decreased (0.3) to the engagement indicator compared from 2020 (3.92 out of a 5-point scale). Implication for practice: The results of the study added new knowledge to nursing science in nursing staff management as it specifically relates to promoting joy at work in nursing staff and transformational leadership in nurse managers. Nurse managers can utilize this project in similar healthcare settings. The project also provided an alternative way in creating a positive work environment through changing practices and improving satisfaction, engagement, and reducing turnover as outcomes. |
