Updated: 04/22/25
Updated: 04/22/25
Explore the development and implementation of an innovative emergency department (ED) transition program designed to reduce frequent ED visits among patients with low-acuity concerns. The program targets individuals who have visited the ED three or more times in the past year for issues classified as low acuity based on CPT billing codes. Its primary objective is to identify barriers to care, such as access, education, resources, and support, and provide solutions that facilitate care management by the patient’s primary care provider (PCP) or in an urgent care setting. Early data has shown a decrease in low-acuity ED utilization and a increase connectivity to their primary care practitioner.
The program leverages various technologies, including routine telephonic outreach and scheduled educational communications via text, mail, and EHR options. A care coordinator works in collaboration with managed care organizations (MCOs) to inform patients about available resources and educational platforms provided by their insurance. Patients are contacted approximately one week after an ED visit to introduce the program and assess barriers to care. Based on individual needs, the care coordinator provides tailored resources and support.
Each enrolled patient receives a personalized call plan by mail, detailing information such as PCP hours, nearest urgent care facilities, poison control contacts, and various support options, including a nurse advice line. Monthly educational content is delivered via text, focusing on common childhood illnesses and their management, with topics selected based on seasonal trends.
Additionally, if a patient returns to the ED for further low-acuity visits while enrolled in the program, a notification is sent to the care coordinator, enabling timely re-education and support for the family.
Learning objectives: Explain the importance of guiding families in selecting appropriate care levels for common or low-acuity childhood illnesses. Demonstrate how to educate families on choosing the right level of care for common childhood illnesses. Analyze the factors contributing to frequent ED visits for low-acuity concerns. Evaluate the effectiveness of different educational strategies in guiding families to appropriate care levels.
Outcomes for the ED transition program: Reduced ED utilization: Decrease the number of low-acuity ED visits among enrolled patients within a specified timeframe (e.g., 6 months) compared to a baseline. Improved access to primary care: Increase the number of patients accessing their primary care provider for non-emergency health concerns, leading to timely and appropriate care. Enhanced patient education: Increase patient and caregiver knowledge regarding common childhood illnesses and appropriate care settings. Increased resource utilization: Promote the use of alternative resources, such as urgent care facilities and telehealth services, resulting in a shift from ED reliance. Barrier identification and mitigation: Successfully identify and address specific barriers to care through follow-up assessments, leading to tailored solutions for individual families. Referral to appropriate care: Increase the number of referrals made to community resources and support services that address identified barriers, such as transportation or financial assistance. Monitoring and re-education: Implement an effective monitoring system that triggers timely follow-up for patients returning to the ED, ensuring that re-education and support are provided as needed.
The program leverages various technologies, including routine telephonic outreach and scheduled educational communications via text, mail, and EHR options. A care coordinator works in collaboration with managed care organizations (MCOs) to inform patients about available resources and educational platforms provided by their insurance. Patients are contacted approximately one week after an ED visit to introduce the program and assess barriers to care. Based on individual needs, the care coordinator provides tailored resources and support.
Each enrolled patient receives a personalized call plan by mail, detailing information such as PCP hours, nearest urgent care facilities, poison control contacts, and various support options, including a nurse advice line. Monthly educational content is delivered via text, focusing on common childhood illnesses and their management, with topics selected based on seasonal trends.
Additionally, if a patient returns to the ED for further low-acuity visits while enrolled in the program, a notification is sent to the care coordinator, enabling timely re-education and support for the family.
Learning objectives: Explain the importance of guiding families in selecting appropriate care levels for common or low-acuity childhood illnesses. Demonstrate how to educate families on choosing the right level of care for common childhood illnesses. Analyze the factors contributing to frequent ED visits for low-acuity concerns. Evaluate the effectiveness of different educational strategies in guiding families to appropriate care levels.
Outcomes for the ED transition program: Reduced ED utilization: Decrease the number of low-acuity ED visits among enrolled patients within a specified timeframe (e.g., 6 months) compared to a baseline. Improved access to primary care: Increase the number of patients accessing their primary care provider for non-emergency health concerns, leading to timely and appropriate care. Enhanced patient education: Increase patient and caregiver knowledge regarding common childhood illnesses and appropriate care settings. Increased resource utilization: Promote the use of alternative resources, such as urgent care facilities and telehealth services, resulting in a shift from ED reliance. Barrier identification and mitigation: Successfully identify and address specific barriers to care through follow-up assessments, leading to tailored solutions for individual families. Referral to appropriate care: Increase the number of referrals made to community resources and support services that address identified barriers, such as transportation or financial assistance. Monitoring and re-education: Implement an effective monitoring system that triggers timely follow-up for patients returning to the ED, ensuring that re-education and support are provided as needed.
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: 04/22/25
Updated: 04/22/25
Purpose: A challenge faced by the medical group (MG) is ensuring nursing professional development practitioners (NPDP) can effectively reach 6500 teammates (TMs). This led to a lack of standardization across 35-plus specialty departments and 400 practice locations spanning three states. The purpose is to establish a unified, evidence-based approach to meet the learning needs and competencies of teammates (TMs), regardless of their specialty or location. The nursing education and professional development team, consisting of ten NPDP members, has used data from various sources, such as surveys, quality indicators, incident reports, and observations, to assess the current gaps and needs of the TMs and leaders. The NPDP team developed and implemented numerous tools and tactics, leveraging technology to enhance our department’s mission of a system-standard, regionally delivered, and locally present process of educational offerings.
Description: We used principles of adult learning, innovation, and interactivity to design and deliver educational offerings based on identified educational gaps by leveraging technology platforms such as virtual meetings and escape rooms, video animations, whiteboards, web-based tools, polling options, and breakout rooms to create engaging educational offerings for our MG audience. These offerings included orientation programs, virtual preceptor/leader meetings, just-in-time training, site visits, microburst educational offerings, and interactive newsletters. By experimenting and being mindful of opportunities, we discovered effective methods to incorporate our educational strategies, helping us attract a broader audience. We have seen an improvement in the quality and safety of patient care, which aligns with the organizational vision and goals of the MG.
Evaluation: By reviewing feedback, surveys, and analytics, we tracked attendance and participation in our programs. Throughout this process, we experimented with different methods of education offerings, encountering setbacks but also many successes. Some strategies achieved a significant return on investment, increasing participation per offering from an average 5-15 TMs to 160- 640 TMs. We also evaluated the quality of our programs which showed TMs have appreciated the benefits and have shared their value with coworkers, indicating that we are meeting the needs of our audience. We learned how to create a positive economic outcome for our organization using various technology platforms to connect with our MG TMs, even though we have a small number of NPDPs and a large geographic range. Utilizing our current tools and tactics, we are confident that our team can provide a sustainable and standardized educational approach that is regionally delivered while maintaining a locally present commitment to the MG.
Description: We used principles of adult learning, innovation, and interactivity to design and deliver educational offerings based on identified educational gaps by leveraging technology platforms such as virtual meetings and escape rooms, video animations, whiteboards, web-based tools, polling options, and breakout rooms to create engaging educational offerings for our MG audience. These offerings included orientation programs, virtual preceptor/leader meetings, just-in-time training, site visits, microburst educational offerings, and interactive newsletters. By experimenting and being mindful of opportunities, we discovered effective methods to incorporate our educational strategies, helping us attract a broader audience. We have seen an improvement in the quality and safety of patient care, which aligns with the organizational vision and goals of the MG.
Evaluation: By reviewing feedback, surveys, and analytics, we tracked attendance and participation in our programs. Throughout this process, we experimented with different methods of education offerings, encountering setbacks but also many successes. Some strategies achieved a significant return on investment, increasing participation per offering from an average 5-15 TMs to 160- 640 TMs. We also evaluated the quality of our programs which showed TMs have appreciated the benefits and have shared their value with coworkers, indicating that we are meeting the needs of our audience. We learned how to create a positive economic outcome for our organization using various technology platforms to connect with our MG TMs, even though we have a small number of NPDPs and a large geographic range. Utilizing our current tools and tactics, we are confident that our team can provide a sustainable and standardized educational approach that is regionally delivered while maintaining a locally present commitment to the MG.
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.
P045 - We Can't Fix It If We Don't Know About It: Increasing Event Reporting with a QuickSubmit Form
Tara Woodside, DNP, RN, Ambulatory Patient Safety and Accreditation Program Manager, ChristianaCare
Updated: 04/22/25
Updated: 04/22/25
The widespread perception throughout the healthcare system in the United States is that ambulatory care is a safer, lower risk environment for patients and caregivers. This is despite the complex dynamics that exist in the ambulatory care space, including multiprofessional teams, transitions of care across multiple specialties, and a dependence on the patient’s ability to self-manage complex conditions. The literature also reflects that a primary barrier to caregiver event reporting is the perceived lack of time to report. The baseline average event reporting time across the health system was 10 minutes, with an average event reporting time of 12 minutes in the ambulatory care practices. This provided an opportunity identified by an interdisciplinary team including nursing, physicians, practice leadership, and front-line caregivers to put in place an evidence-based intervention. The goal was to design and implement a QuickSubmit event reporting form, decrease the amount of time it takes to submit an event report by 25%, and therefore increase the total number of events entered by 10%.
The intervention was the customization of a QuickSubmit form designed by the interdisciplinary team in the enterprise’s reporting platform. Specific interventions included improving user interface by reduction of required redundant fields, use of natural language prompts in place of the severity level scale, instructions for the brief factual description portion of the form, and a single point of reporting for multiple patient-centered general event types, resulting in a shortened event report form with a more intuitive and time-saving workflow for caregivers entering events. The project was piloted in six primary care practices for three months followed by implementation enterprise wide.
Baseline data reflects an average event report submission time of 12 minutes in ambulatory care practices. Post-intervention, the time to enter an event report submission decreased by 48.3% or 6.23 minutes. Statistical analysis of the length of time it took to submit a standard event submission report vs. the QuickSubmit event submission report showed statistical significance with a p = 0.0064 with a confidence interval 95% (1.83-10.65). The average number of event submissions increased from 6.5 per month to 9.75, which is an increase of 50%.
Therefore, the results demonstrate the effectiveness of the interventions by surpassing the goal to decrease event reporting time by 25% and increase number of event reports submitted by 10%.
The goal of decreasing event reporting time and increasing number of event submissions entered was met and surpassed. The results indicate a 48.3% decrease in time to report an event using the QuickSubmit form intervention. The results also reflect a 50% increase in the average number of event submissions using the QuickSubmit form intervention. The implementation of a QuickSubmit form eliminating redundancy, using plain-language questions, providing guidance, and allowing for a single point of reporting for multiple event types, proved effective.
Lessons learned include caregiver relationship building and consistent messaging are foundational to establishing engagement and caregiver awareness at the local level.
The intervention was the customization of a QuickSubmit form designed by the interdisciplinary team in the enterprise’s reporting platform. Specific interventions included improving user interface by reduction of required redundant fields, use of natural language prompts in place of the severity level scale, instructions for the brief factual description portion of the form, and a single point of reporting for multiple patient-centered general event types, resulting in a shortened event report form with a more intuitive and time-saving workflow for caregivers entering events. The project was piloted in six primary care practices for three months followed by implementation enterprise wide.
Baseline data reflects an average event report submission time of 12 minutes in ambulatory care practices. Post-intervention, the time to enter an event report submission decreased by 48.3% or 6.23 minutes. Statistical analysis of the length of time it took to submit a standard event submission report vs. the QuickSubmit event submission report showed statistical significance with a p = 0.0064 with a confidence interval 95% (1.83-10.65). The average number of event submissions increased from 6.5 per month to 9.75, which is an increase of 50%.
Therefore, the results demonstrate the effectiveness of the interventions by surpassing the goal to decrease event reporting time by 25% and increase number of event reports submitted by 10%.
The goal of decreasing event reporting time and increasing number of event submissions entered was met and surpassed. The results indicate a 48.3% decrease in time to report an event using the QuickSubmit form intervention. The results also reflect a 50% increase in the average number of event submissions using the QuickSubmit form intervention. The implementation of a QuickSubmit form eliminating redundancy, using plain-language questions, providing guidance, and allowing for a single point of reporting for multiple event types, proved effective.
Lessons learned include caregiver relationship building and consistent messaging are foundational to establishing engagement and caregiver awareness at the local level.
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.
Tara Woodside, DNP, RN, Ambulatory Patient Safety and Accreditation Program Manager, ChristianaCare
Updated: 04/22/25
Updated: 04/22/25
Patient safety has traditionally focused on inpatient care with little focus and interventions in ambulatory care, largely due to the perception of more control in the inpatient environment. To build and sustain an ambulatory care safety program, leaders must prioritize patient safety, dedicating a team to report monitoring and analysis. The interdisciplinary team, including nursing, advance practice clinicians, physicians, practice leadership, risk management, coding and compliance, and patient relations, implemented evidence-based practice (EBP) interventions based on the change management theory. With an organizational goal of reducing preventable harm, the goal was to establish a separate, non-acute focused, EBP patient safety program unique to ambulatory care by increasing event reporting by 5%. Baseline data of ambulatory care event report numbers were obtained from the organization’s event reporting platform for the intervention period dates one year prior. The baseline average event report submission per month for October 2022 to April 2023 was 111.
Multiple layered EBP interventions were implemented including defining metrics and establishing standard reports for tracking metrics, identifying ambulatory caregivers for event report analysis, shortening the event report form and reducing the use of technical terms, performing leadership rounding and facilitating caregiver recognition, and consistently communicating safety metrics. The creation of a shortened event report form with fewer technical terms was piloted in six primary care practices from June to October 2023. Due to increased event report submissions, the shortened event review form was introduced enterprise-wide in November 2023. This, in addition to the introduction of a monthly ambulatory care safety newsletter in January 2024 as well as close adherence to regular presentations using a cohesive image and consistent metric reporting beginning in November 2023, aligns with the increase in ambulatory care event reports.
Baseline data reflecting the number of event reports submitted between October 2022 and April 2023 show an average of 111 ambulatory care event submissions per month. Following the application of multiple EBP interventions aligned with the change management theory, the average number of ambulatory care event submissions per month increased to 124. The key measurement was a 11.7% increase in ambulatory care event report submissions, The results demonstrate the effectiveness of the interventions and surpassed the 10% reach goal.
The goal of increasing ambulatory care event submissions was met and surpassed. The results indicate an 11.7% increase from October 2023 to April 2024 compared to the same period the year prior. Multifaceted, layered interventions with an audience of interdisciplinary caregivers provided an effective mechanism.
Lessons learned include the broader scope of repetitive, consistent messaging coupled with specific relationship building is foundational to establishing engagement in event reporting at the local level. Awareness of the shortened event report form as well as identification of local practice safety champions continue to be opportunities moving forward. The ambulatory care patient safety program is designed to be replicated either as a whole or using individual interventions over time, based on an organization’s or department’s resources.
Multiple layered EBP interventions were implemented including defining metrics and establishing standard reports for tracking metrics, identifying ambulatory caregivers for event report analysis, shortening the event report form and reducing the use of technical terms, performing leadership rounding and facilitating caregiver recognition, and consistently communicating safety metrics. The creation of a shortened event report form with fewer technical terms was piloted in six primary care practices from June to October 2023. Due to increased event report submissions, the shortened event review form was introduced enterprise-wide in November 2023. This, in addition to the introduction of a monthly ambulatory care safety newsletter in January 2024 as well as close adherence to regular presentations using a cohesive image and consistent metric reporting beginning in November 2023, aligns with the increase in ambulatory care event reports.
Baseline data reflecting the number of event reports submitted between October 2022 and April 2023 show an average of 111 ambulatory care event submissions per month. Following the application of multiple EBP interventions aligned with the change management theory, the average number of ambulatory care event submissions per month increased to 124. The key measurement was a 11.7% increase in ambulatory care event report submissions, The results demonstrate the effectiveness of the interventions and surpassed the 10% reach goal.
The goal of increasing ambulatory care event submissions was met and surpassed. The results indicate an 11.7% increase from October 2023 to April 2024 compared to the same period the year prior. Multifaceted, layered interventions with an audience of interdisciplinary caregivers provided an effective mechanism.
Lessons learned include the broader scope of repetitive, consistent messaging coupled with specific relationship building is foundational to establishing engagement in event reporting at the local level. Awareness of the shortened event report form as well as identification of local practice safety champions continue to be opportunities moving forward. The ambulatory care patient safety program is designed to be replicated either as a whole or using individual interventions over time, based on an organization’s or department’s resources.
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: 04/22/25
Updated: 04/22/25
As defined by the Beryl Institute, patient experience is “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” A review of literature suggests that evidence-based best practices can positively impact the patient experience. Practices common in service industries known to improve customer experience include AIDET (acknowledge, introduce, duration, explanation, thank), HEAT (hear, empathize, apologize, take action),and teach-back. One healthcare organization includes almost 200 ambulatory care practices in four states. The organization identified a strategic goal to implement an evidence-based best practice bundle within the ambulatory care setting to improve patient experience scores and survey comments. A collaborative team inclusive of nurse leaders, a patient experience program manager, and a patient education specialist spearheaded bundle implementation across all patient-facing roles with advisement from a patient experience subcommittee that included ambulatory care operational and clinical leadership stakeholders. The bundle was initially implemented in the women and children’s service line and the cancer service line and subsequently in the remaining practices. The goal was to increase patient experience survey metrics for courtesy and respect, teach-back, and likelihood to recommend practice for ambulatory care practices by two percentile rank points by the end of the fiscal year.
The bundle components selected to improve patient experience metrics were AIDET, HEAT, and teach-back. The implementation plan included providing resources on bundle components to practice clinical and operational leaders, education for all staff who interact with patients, and an observation mechanism. Staff was assigned online learning for each bundle component, and leaders observed staff, provided real-time feedback, and documented rounding in the organization’s tool.
Key outcome measures were patient survey metrics for courtesy and respect, teach-back and likelihood to recommend practice, and comments related to these themes. Comparison of quantitative data demonstrated that the targeted improvement was exceeded for several metrics in both service lines in the initial launch. Comparison of qualitative data showed a decrease in the percentage of negative comments in multiple areas for both service lines. Process measures evaluated were bundle online learning completion rates and number of observations documented within the tool.
The goal of improving several patient experience survey metrics through the implementation of an evidence-based intervention bundle was achieved. A structure for observations was created, real-time feedback and coaching at the local level occurred, and a culture of accountability was cultivated around the bundle within each service line.
Lessons learned include the value of engaging stakeholders through collaboration with the patient experience subcommittee and the need for a streamlined mechanism for provider outreach, engagement, and education. Next steps include ongoing data collection to evaluate impact across all service lines, development of a job aid for tracking practice-level metrics, quarterly reminders to practice leaders, and inclusion of the bundle components in orientation for new leaders and caregivers.
Following this presentation, conference attendees will be able to describe how ambulatory care nurses can promote change and influence outcomes by implementing interventions to improve patient experience in collaboration with clinical and operational leadership.
The bundle components selected to improve patient experience metrics were AIDET, HEAT, and teach-back. The implementation plan included providing resources on bundle components to practice clinical and operational leaders, education for all staff who interact with patients, and an observation mechanism. Staff was assigned online learning for each bundle component, and leaders observed staff, provided real-time feedback, and documented rounding in the organization’s tool.
Key outcome measures were patient survey metrics for courtesy and respect, teach-back and likelihood to recommend practice, and comments related to these themes. Comparison of quantitative data demonstrated that the targeted improvement was exceeded for several metrics in both service lines in the initial launch. Comparison of qualitative data showed a decrease in the percentage of negative comments in multiple areas for both service lines. Process measures evaluated were bundle online learning completion rates and number of observations documented within the tool.
The goal of improving several patient experience survey metrics through the implementation of an evidence-based intervention bundle was achieved. A structure for observations was created, real-time feedback and coaching at the local level occurred, and a culture of accountability was cultivated around the bundle within each service line.
Lessons learned include the value of engaging stakeholders through collaboration with the patient experience subcommittee and the need for a streamlined mechanism for provider outreach, engagement, and education. Next steps include ongoing data collection to evaluate impact across all service lines, development of a job aid for tracking practice-level metrics, quarterly reminders to practice leaders, and inclusion of the bundle components in orientation for new leaders and caregivers.
Following this presentation, conference attendees will be able to describe how ambulatory care nurses can promote change and influence outcomes by implementing interventions to improve patient experience in collaboration with clinical and operational leadership.
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: 04/22/25
Updated: 04/22/25
Background: Genetics and lifestyle choices can affect one’s overall health and poor diet, and exercise can contribute to conditions such as hypertension and diabetes. An unhealthy lifestyle affects the individual and the overall health of the workplace. To improve the health of team members with chronic or pre-chronic conditions, a wellness program was developed.
The program named HALO (healthy actions for lifelong outcomes) was designed to improve health outcomes for team members with eligible chronic conditions and preventative care needs. The goal of the program was to empower participants to improve and manage their health using an individualized plan specific to their goals. By combining preventative medical examination with motivational interviewing during personalized meetings, the aim was to improve upon several metrics. The program evaluated metrics such as lab work, blood pressure, and body analysis to set health goals during the initial session. Health coaching techniques were implemented during monthly sessions guiding the participant to make lifestyle changes and reach their health goal(s).
Methods: The first cohort consisted of 85 team members from a large hospital system. Team members were from a variety of departments. Each participant had baseline labs drawn in the team member clinic; labs drawn included a lipid panel and A1C. Blood pressure was taken, and a body analysis was conducted using a body analysis scale. Results were reviewed with the participant during an individual session by a registered nurse certified as a health and well-being coach. During the initial session, health goals were determined. Subsequent coaching with motivational interviewing up to 7 sessions within 6 months took place. All sessions were conducted either in-person or virtually with an RN-certified health and well-being coach. At the 6-month mark labs were redrawn and progress toward health goal(s) was determined. Participants were followed up at 6-month intervals for a total of 18 months participation in the HALO program. Participants were rewarded with virtual cash which can be used to buy gift cards, $25 for each goal up to 3 at the first 6-month checkup and $50 for each goal up to 3 at the 12- and 18-month checkups.
Results: Of the 85 participants who began in the first cohort, 70 participants completed 18 months of the program. Overall positive gains were made across the board. Participation in the HALO program exhibited decreases in eight biometric indicators: decreasing systolic blood pressure (4.9%), diastolic blood pressure (.66%), A1C (3.4%), BMI (6.64%), body fat percentage (5.96%), total cholesterol (5.55%), LDL (7.28%), and triglycerides (3.4%) along with an increase in HDL (4.98%) all of which improves health outcomes.
Conclusion: The HALO program combining preventative medical examination and one-on-one coaching contributed to success in health outcomes in most of the participants. Following participants for 18 months ensured that lasting lifestyle changes were achieved. Since the first cohort, there have been 180 more team members enrolled and progressing toward their health goals.
The program named HALO (healthy actions for lifelong outcomes) was designed to improve health outcomes for team members with eligible chronic conditions and preventative care needs. The goal of the program was to empower participants to improve and manage their health using an individualized plan specific to their goals. By combining preventative medical examination with motivational interviewing during personalized meetings, the aim was to improve upon several metrics. The program evaluated metrics such as lab work, blood pressure, and body analysis to set health goals during the initial session. Health coaching techniques were implemented during monthly sessions guiding the participant to make lifestyle changes and reach their health goal(s).
Methods: The first cohort consisted of 85 team members from a large hospital system. Team members were from a variety of departments. Each participant had baseline labs drawn in the team member clinic; labs drawn included a lipid panel and A1C. Blood pressure was taken, and a body analysis was conducted using a body analysis scale. Results were reviewed with the participant during an individual session by a registered nurse certified as a health and well-being coach. During the initial session, health goals were determined. Subsequent coaching with motivational interviewing up to 7 sessions within 6 months took place. All sessions were conducted either in-person or virtually with an RN-certified health and well-being coach. At the 6-month mark labs were redrawn and progress toward health goal(s) was determined. Participants were followed up at 6-month intervals for a total of 18 months participation in the HALO program. Participants were rewarded with virtual cash which can be used to buy gift cards, $25 for each goal up to 3 at the first 6-month checkup and $50 for each goal up to 3 at the 12- and 18-month checkups.
Results: Of the 85 participants who began in the first cohort, 70 participants completed 18 months of the program. Overall positive gains were made across the board. Participation in the HALO program exhibited decreases in eight biometric indicators: decreasing systolic blood pressure (4.9%), diastolic blood pressure (.66%), A1C (3.4%), BMI (6.64%), body fat percentage (5.96%), total cholesterol (5.55%), LDL (7.28%), and triglycerides (3.4%) along with an increase in HDL (4.98%) all of which improves health outcomes.
Conclusion: The HALO program combining preventative medical examination and one-on-one coaching contributed to success in health outcomes in most of the participants. Following participants for 18 months ensured that lasting lifestyle changes were achieved. Since the first cohort, there have been 180 more team members enrolled and progressing toward their health goals.
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.
Natalie Rogers, BSN, RN, AMB-BC, Senior Manager, Clinical Services and Operations, Emory Healthcare | Maanowo Ventii, MSN, MBA, RN, CPHQ
Updated: 04/22/25
Updated: 04/22/25
Purpose: Design and implement an interactive, experiential clinical message management (CMM) class to provide ambulatory care clinical staff with intensive training to gain in-depth knowledge and competency in managing EMR clinical messages in a safe and timely manner using standardized workflows. Improve patient quality and safety outcomes by decreasing message response times and touchpoints. Increase staff satisfaction in their roles by providing relevant and comprehensive training materials.
Description: A large academic healthcare system (AHS) transitioned to a new electronic medical record (EMR) system in October 2022. The EMR vendor trained the AHS staff prior to go-live using their proprietary training modules via their virtual platform.
The EMR system’s training modules focused primarily on the technical steps and functionalities for managing various types of clinical messages. It did not incorporate content specific to the AHS’s workflows. Furthermore, the compendium of training materials provided by the EMR vendor only addressed the technical aspects of working clinical messages within the EMR and did not include practical steps that aligned with the AHS’s specific workflows.
Immediately after go-live, the AHS’s ambulatory care services noticed an astronomical increase in clinical message volumes, call volumes, message touchpoints, turnaround times, and patient complaints. Staff also voiced frustrations about the lack of relevant EMR training prior to go-live and reference materials that they felt did not adequately prepare them to competently perform their job functions.
As a result, ambulatory care created a CMM class for existing and new staff to receive comprehensive training on how to correctly manage clinical messages according to the organization’s specific workflows within the new EMR system. Standardized workflows, step-by-step job aids, interactive case-based clinical message scenarios, and demonstration videos were created.
Evaluation/outcome: Data was obtained and analyzed post-implementation of the CMM class. Accomplishments included a 70% decrease in patient complaints from 90 per month to 27 per month, a 59% decrease in message response times from 2.3 days to 0.95 days, and staff reports of increased satisfaction and competency via the post-class survey.
Description: A large academic healthcare system (AHS) transitioned to a new electronic medical record (EMR) system in October 2022. The EMR vendor trained the AHS staff prior to go-live using their proprietary training modules via their virtual platform.
The EMR system’s training modules focused primarily on the technical steps and functionalities for managing various types of clinical messages. It did not incorporate content specific to the AHS’s workflows. Furthermore, the compendium of training materials provided by the EMR vendor only addressed the technical aspects of working clinical messages within the EMR and did not include practical steps that aligned with the AHS’s specific workflows.
Immediately after go-live, the AHS’s ambulatory care services noticed an astronomical increase in clinical message volumes, call volumes, message touchpoints, turnaround times, and patient complaints. Staff also voiced frustrations about the lack of relevant EMR training prior to go-live and reference materials that they felt did not adequately prepare them to competently perform their job functions.
As a result, ambulatory care created a CMM class for existing and new staff to receive comprehensive training on how to correctly manage clinical messages according to the organization’s specific workflows within the new EMR system. Standardized workflows, step-by-step job aids, interactive case-based clinical message scenarios, and demonstration videos were created.
Evaluation/outcome: Data was obtained and analyzed post-implementation of the CMM class. Accomplishments included a 70% decrease in patient complaints from 90 per month to 27 per month, a 59% decrease in message response times from 2.3 days to 0.95 days, and staff reports of increased satisfaction and competency via the post-class survey.
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.
Alana Decker, MSN, RN, AMB-BC | Jennifer Walston, DNP, RN, AMB-BC, NEA-BC | Valerie Younce, MSN, RN, AMB-BC
Updated: 04/22/25
Updated: 04/22/25
Learning outcome: After completing this learning activity, the participant will be able to design and implement a layered learning onboarding pathway that integrates education, clinical skills training, EHR simulation, and competency standards.
Purpose: The layered learning program, called Onboarding360, aims to address the lack of system standardization and the overwhelming amount of information ambulatory care new hires currently receive in onboarding. The goal of Onboarding360 is to standardize practice, improve patient quality outcomes, reduce adverse events, and increase new-hire satisfaction and retention. The onboarding program was developed for new-hire clinical staff (RNs, LVNs, and CMAs in primary care and specialty clinics), combining education, clinical skills, EHR simulation, and competency standards in a layered learning approach. Layered learning breaks down complex information into more manageable pieces, building upon the knowledge learned in the previous layer, resulting in a comprehensive learning experience.
Description: The Onboarding360 program was developed by NPD specialist RNs at an academic medical center with 120+ ambulatory care departments. An inventory of required onboarding education, competencies, clinic workflows, and practice needs was analyzed and placed in a layered learning pathway. The new hire progresses through the pathway by attending a series of onboarding classes, starting their first week and at 30, 60, and 90 days. To integrate technical and clinical skills, the classes include didactic learning, hands-on skills, EHR simulation, and mock clinic events. This provides a realistic and safe environment to acquire knowledge and skills to fulfill clinical duties. Implementation included approval from executive leadership and working with facilities and IS/IT teams to set up classrooms and skills labs. The program was presented to nurse leaders and operations managers during lunch-and-learn information sessions. Preceptors participated in refresher training focused on the layered learning pathway to ensure alignment between Onboarding360 classes and in-clinic training.
Evaluation: The program started on August 26, 2023, with 15 successful cohorts to date. Patient quality outcomes improved from 4.13 (July 2023) to 4.54 (February 2024), exceeding the organization’s goal of 4.42, on a 5-point scale. Improvement in patient quality outcomes confirms that new-hire staff are addressing patient care gaps and wellness needs. Adverse events (medication errors, specimen labeling, and falls) were reduced by 21% over the 9-month post-implementation period. Overall satisfaction with Onboarding360 was reported through new-hire surveys. The initial class session surveys averaged 4.64 out of a 5-point Likert scale in overall satisfaction, with a steady increase over each class session, ending at 4.9 for the 90-day classes. The retention rate for staff who completed Onboarding360 as of June 2024 is 83%, compared to the region's overall retention rate of 79%.
Purpose: The layered learning program, called Onboarding360, aims to address the lack of system standardization and the overwhelming amount of information ambulatory care new hires currently receive in onboarding. The goal of Onboarding360 is to standardize practice, improve patient quality outcomes, reduce adverse events, and increase new-hire satisfaction and retention. The onboarding program was developed for new-hire clinical staff (RNs, LVNs, and CMAs in primary care and specialty clinics), combining education, clinical skills, EHR simulation, and competency standards in a layered learning approach. Layered learning breaks down complex information into more manageable pieces, building upon the knowledge learned in the previous layer, resulting in a comprehensive learning experience.
Description: The Onboarding360 program was developed by NPD specialist RNs at an academic medical center with 120+ ambulatory care departments. An inventory of required onboarding education, competencies, clinic workflows, and practice needs was analyzed and placed in a layered learning pathway. The new hire progresses through the pathway by attending a series of onboarding classes, starting their first week and at 30, 60, and 90 days. To integrate technical and clinical skills, the classes include didactic learning, hands-on skills, EHR simulation, and mock clinic events. This provides a realistic and safe environment to acquire knowledge and skills to fulfill clinical duties. Implementation included approval from executive leadership and working with facilities and IS/IT teams to set up classrooms and skills labs. The program was presented to nurse leaders and operations managers during lunch-and-learn information sessions. Preceptors participated in refresher training focused on the layered learning pathway to ensure alignment between Onboarding360 classes and in-clinic training.
Evaluation: The program started on August 26, 2023, with 15 successful cohorts to date. Patient quality outcomes improved from 4.13 (July 2023) to 4.54 (February 2024), exceeding the organization’s goal of 4.42, on a 5-point scale. Improvement in patient quality outcomes confirms that new-hire staff are addressing patient care gaps and wellness needs. Adverse events (medication errors, specimen labeling, and falls) were reduced by 21% over the 9-month post-implementation period. Overall satisfaction with Onboarding360 was reported through new-hire surveys. The initial class session surveys averaged 4.64 out of a 5-point Likert scale in overall satisfaction, with a steady increase over each class session, ending at 4.9 for the 90-day classes. The retention rate for staff who completed Onboarding360 as of June 2024 is 83%, compared to the region's overall retention rate of 79%.
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: 04/22/25
Updated: 04/22/25
Objective: The technique to obtain blood pressure using a manual method has been updated, thus leading to a knowledge gap among medical assistants, nurses, and pharmacists in the ambulatory care setting. This gap, along with the lack of standard process for obtaining rechecked blood pressures, led to unnecessary diagnosis of hypertension, inappropriate antihypertensive medication initiation, and/or adjustments.
Learning outcome: The learning outcome of this quality improvement project was to increase the rate of elevated blood pressures being rechecked by 10%. Medical assistants, nurses, and pharmacists completed training on updated manual blood pressure techniques. Organizational thresholds define elevated blood pressure as systolic: >140 and diastolic: >90.
Methods: The affected population included patients 18 years and older in the ambulatory care setting. Practice locations identified medical assistants, nurses, and pharmacists to function as “blood pressure trainers.” Trainers completed in-person training sessions led by the nursing professional development practitioners and training materials from the American Medical Association and the American Heart Association M.A.P. BP program. This program included an online learning module, infographics for patient positioning, and forms to document training. Trainers then provided live, in-person training to their practice location using return demonstration and teach-back methods and documented completion of the in-person training and online module. Each practice location defined a process for completing blood pressure rechecks for patients experiencing elevated blood pressure.
Results: Blood pressure recheck quality improvement timeline: Between April 1-30, 2023: Rate of rechecked elevated blood pressures was 29.34% (3,713 of 12,656 patients). June 30, 2023: Training sessions were completed at each practice location. Between July 1 - September 30, 2023: Rate of rechecked blood pressure was 43.51% (5,049 patients), a 14.17% improvement. Since training implementation, the rate of rechecked elevated blood pressure has improved by 28.28%, totaling 57.62% rechecks. 49% of patients with an initially elevated blood pressure were below threshold upon recheck.
Conclusions: Completion of training and implementation of a standard blood pressure recheck process have led to a reduction of patients identified as having hypertension, prevention of unnecessary antihypertensive medication initiation, and modifications from inaccurate readings. Using evidence-based practices, the team was able to increase team member knowledge, skill, and engagement in the management of hypertension in the ambulatory care setting.
Learning outcome: The learning outcome of this quality improvement project was to increase the rate of elevated blood pressures being rechecked by 10%. Medical assistants, nurses, and pharmacists completed training on updated manual blood pressure techniques. Organizational thresholds define elevated blood pressure as systolic: >140 and diastolic: >90.
Methods: The affected population included patients 18 years and older in the ambulatory care setting. Practice locations identified medical assistants, nurses, and pharmacists to function as “blood pressure trainers.” Trainers completed in-person training sessions led by the nursing professional development practitioners and training materials from the American Medical Association and the American Heart Association M.A.P. BP program. This program included an online learning module, infographics for patient positioning, and forms to document training. Trainers then provided live, in-person training to their practice location using return demonstration and teach-back methods and documented completion of the in-person training and online module. Each practice location defined a process for completing blood pressure rechecks for patients experiencing elevated blood pressure.
Results: Blood pressure recheck quality improvement timeline: Between April 1-30, 2023: Rate of rechecked elevated blood pressures was 29.34% (3,713 of 12,656 patients). June 30, 2023: Training sessions were completed at each practice location. Between July 1 - September 30, 2023: Rate of rechecked blood pressure was 43.51% (5,049 patients), a 14.17% improvement. Since training implementation, the rate of rechecked elevated blood pressure has improved by 28.28%, totaling 57.62% rechecks. 49% of patients with an initially elevated blood pressure were below threshold upon recheck.
Conclusions: Completion of training and implementation of a standard blood pressure recheck process have led to a reduction of patients identified as having hypertension, prevention of unnecessary antihypertensive medication initiation, and modifications from inaccurate readings. Using evidence-based practices, the team was able to increase team member knowledge, skill, and engagement in the management of hypertension in the ambulatory care setting.
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: 04/22/25
Updated: 04/22/25
Purpose: In 2021, licensed and unlicensed staff at a greater Houston area ambulatory care setting performed inaccurate blood pressure (BP) measurements. This contributed to the Healthcare Effectiveness Data and Information Set (HEDIS) scores of 59% for controlling BP and 69.9% for high blood pressure control in patients with diabetes
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.
