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P053 - Innovating Nursing Education: The LPN Academy’s Path to Excellence
Emily Jax, MSN, RN, NPD-BC

Updated: 04/22/25

Updated: 04/22/25
In the dynamic setting of a community internal medicine (CIM) clinic, the adverse effects of the nationwide licensed practical nurse (LPN) recruitment crisis and ongoing understaffing became untenable. The clinic struggled with up to eight unfilled LPN positions simultaneously, with a constant churn of LPNs getting hired and resigning rapidly leading to a high attrition rate among newly hired LPNs. This level of turnover necessitated constant onboarding, resulting in staff fatigue within the CIM team. In addition to eroding a positive work atmosphere, frequent attrition presented a significant financial burden on the department. According to the US Bureau of Labor and Statistics, the average hourly salary of the LPN is $28.72 (2024). Taking that into account, the orientation of an LPN costs approximately $6,893 per orientee.
To counter these obstacles, an interdisciplinary initiative comprising key stakeholders such as physicians, nurse managers, nurse supervisors, nurse administrators, NPD practitioners, and preceptors resulted in the establishment of an innovative LPN Academy. By synthesizing insights from a literature review of distantly similar LPN orientation programs, the academy was structured with an eight-week timeline, aiming to support and foster professional growth, thereby reducing attrition rates.
The nurse manager and supervisor initiated the recruitment process by engaging with LPN students at local community colleges, creating a welcoming pathway for new graduates.
Concurrently, leadership and nursing profession development (NPD) practitioners consulted with the nurse residency program director for registered nurses (RNs) to set program standards and define initial goals and expectations. NPD practitioners developed a curriculum facilitating the transition of newly graduated LPNs into the clinical setting. The content incorporated adult learning principles through multimodal sessions covering professional communication, clinical skills, and ongoing growth and development opportunities.
The LPN Academy, comprising eight 1-hour sessions, merges educational content with interactive activities, providing a forum to address cohort-specific queries. Nursing leadership ensured LPNs were able to attend with dedicated time for all sessions.
Program effectiveness was assessed through pre- and post-session surveys measuring LPN knowledge, attitudes, and skills. A comprehensive evaluation at the program’s conclusion focused on metrics such as LPN comfort levels, content satisfaction, knowledge acquisition, and clinical practice impact. After one year, five of six cohort members remained within CIM.
Survey results demonstrated a significant improvement in comfort levels, knowledge acquisition, and resource utilization across all topics introduced from the beginning to the end of the program. All LPNs who successfully completed the academy expressed their endorsement of the program to other novice LPNs.
18 months following the implementation of the academy, the average number of LPN vacancies decreased from eight to three. The LPN Academy successfully graduated five LPNs across two cohorts, resulting in a retention rate of 83%, saving $34,000 in orientation costs.

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.

P054 - A Confidence Boost: Utilizing Supplemental Education to Improve Ambulatory Care Emergency Responses
Barbara DeLeon, MSHA, BSN, RN

Updated: 04/22/25

Updated: 04/22/25
Background: In 2010, the American healthcare system experienced an increased growth in the ambulatory care setting with the enactment of the Affordable Care Act. As ambulatory care visits continue to increase, so does the potential for medical emergencies within the ambulatory care setting. It is imperative that the ambulatory care team is prepared to respond to medical emergencies involving patients, caregivers, and staff members.
Problem: In 2023, 18 pediatric specialty clinics that are located on the same campus as a large urban 486-bed medical center in Fort Worth, Texas, experienced a significant building expansion. The expansion brought an increase in patient visits and emergency medical alerts. The 2023/2024 fiscal year saw 142,077 clinic visits and 21 emergency medical alerts. Code debriefing identified staff’s lack of familiarity with the crash cart, code medication, defibrillator, and oxygen delivery devices and poor code documentation. Although current resuscitation training for clinical staff consisted of basic life support (BLS) in addition to pediatric advanced life support (PALS) every 2 years and an annual mock code in the simulation lab for nurses, staff voiced a lack of confidence in their ability to manage medical emergencies.
Method: The American Heart Association (AHA) has recognized this problem and recommends booster training events. A multimodal booster training approach was proposed to address the knowledge and skills gaps. The proposed multimodal education plan comprised of a combination of activities to include in situ low-fidelity mock codes, learning systems curricula, and hands-on training for the defibrillator, oxygen delivery devices, and documentation and a crash cart scavenger hunt. This QI project was based on the plan-do-study-act (PDSA) model. The PDSA provides a framework for testing changes, learning from each test, and refining changes through subsequent PDSA cycles.
Results: In 2024, the proposed education events were conducted onsite in eight specialty clinics over a three-month period. A baseline comfortability survey utilizing a 5-point Likert scale ranging from “not confident at all” to “very confident” was administered 30 days prior to the education events. Immediately upon completion of the events, a post-survey was completed. Each survey question indicated an increase in staff confidence. Upon comparison of the baseline and post-survey levels, the level of staff confidence reflected a mean increase ranging from 12% to 51% with an average overall increase of 27%.
Discussion: Survey results showed a significant increase in staff member confidence to perform the skills required for management of medical emergencies. Further assessment will need to take place to determine comfort retention. During the education process the need to include front desk staff in future training was identified. Front desk staff are often the first responders to medical events that happen in the patient waiting area and receive little to no training on the topic.
Implications/conclusions: The project’s positive results supports the AHA’s s guideline that the addition of booster training to resuscitation courses is associated with improved cardiopulmonary resuscitation skill retention over time.

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.

P055 - Enhancing the Efficacy of Depression Screening within the Ambulatory Care Setting
Carla Parker, MSN, RN, AMB-BC, Director of Nursing Operations in Ambulatory, Inova Health System

Updated: 04/22/25

Updated: 04/22/25
Learning objective: Explain the systematic approach devised and change management required to conduct annual depression screenings in ambulatory care adult specialty clinics to address the growing mental health crisis and improve patient experience and outcomes in addition to exemplify this healthcare organization’s commitment to a comprehensive approach to healthcare and honoring our care mandates.
Purpose: Describe strategies used by a large 200-clinic ambulatory care site to successfully implement depression screening and discuss opportunities for best practices for system-wide change.
Background: Escalating suicide rates and limited mental health service access drive the critical need for depression screenings during healthcare touchpoints, including ambulatory care visits. A multidisciplinary team consisting of members from care transformation, quality improvement, nursing, operations, patient experience, analytics, Epic/IT, and behavioral health subject matter experts was created to devise a systematic approach for conducting universal annual depression screenings.
Methods: Utilizing the EHR, standardized screening tools were seamlessly integrated, allowing for automatic screening of adult patients with tailored educational materials based on their scores. Team members identify a patient’s risk for depression by administering the validated patient health questionnaire (PHQ)-2 screening tool. If the score is three or greater, the PHQ-9 screening tool is administered. Patient responses indicating self-harm intent generate a direct message for care teams to assess patient safety. Real-time safety assessments and collaboration with ambulatory care teams have been established through an internal behavioral health crisis line.
Findings: In April 2023, the annual depression screening was implemented in the specialty setting. By April 10, 2024, a total of 372,844 patients were screened, with 90,095 patients from specialty clinics. Of the patients screened, 0.9% reported severe depression and 1.8% expressed thoughts of suicide or self-harm. With real-time behavioral health support, two designated therapists received 700 calls regarding patients exhibiting signs of severe depression or suicide.
Conclusion: This underscores the effectiveness of collaboration and the screening tool in early identification and intervention. The approach, which combines screening, automation, and swift crisis intervention, has demonstrated significant efficacy in improving patient care and outcomes, addressing rising rates of suicide linked to untreated depression, and highlighting this organization’s commitment to holistic care.
Implications for nursing practice: By prioritizing depression screenings and integrating them into routine patient care, this model serves as a valuable blueprint for other healthcare organizations seeking to enhance mental health care delivery and mitigate the impact of untreated depression on individuals and the community.

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.

P056 - SAME: Safety during Ambulatory Medical Emergencies - An Evidence-Based Practice Project
Rachel Ellis, MSN, RN, AMB-BC, Nurse Manager, General and Trauma Surgery, Inova Health System    |     Carla Parker, MSN, RN, AMB-BC, Director of Nursing Operations in Ambulatory, Inova Health System

Updated: 04/22/25

Updated: 04/22/25
Purpose: Enhance team member (TM) knowledge, confidence, and readiness when responding to an ambulatory care medical emergency.
Background: With increasing healthcare demands and over one billion annual outpatient visits nationwide, ambulatory care TM are asked to manage more acute patients, increasing the risk of an emergency event in the clinic. It is critical that TM are prepared to intervene when emergencies occur. Creating standardized in-situ training for a variable staffing mix is a challenge and no standardized training process exists. Evidence has shown that education and in-situ simulation improve TM readiness to respond to emergencies.
PICO question: Among ambulatory care sites (P), do education and in-situ simulation (I) improve confidence and readiness (O) of team members to respond to patient emergencies when compared to no intervention (C).
Methods: Using the Johns Hopkins nursing evidence-based practice framework to guide evidence translation, this quality improvement pilot project implemented an in-situ training at four ambulatory care sites which included primary care, pediatrics, general surgery, and health equity clinics. The team partnered with an experienced simulation specialist and attended a train-the-trainer session to implement this training at the selected sites. In addition, a curriculum was developed that focused on myocardial infarction and syncope/falls scenarios, which are two common emergency incidents that occur in the clinics. Participants were asked to complete an anonymous pre- and post-survey to measure knowledge about emergency situations and confidence and readiness when responding to emergencies in their workplace. After the completion of the two scenarios and debriefs, participants were provided with a tip sheet summarizing the training as a future educational tool.
Outcomes: Simulations were performed over a 2-month period and included both clinical and nonclinical TM reporting various amounts of time in their role. Descriptive analysis was conducted to determine project outcomes. Over 78% of participants had some form of life support certification. From pre-survey to completion of the two simulations and post-survey, participants reported increased readiness to recognize a medical emergency. Participants expressed increased readiness to provide essential information to other TM during a medical emergency and increased confidence in finding and correctly using equipment in their clinic.
Lessons learned: The project highlighted the value of evidence-based practice in creating effective training programs. The "train-the-trainer" model proved essential for successful implementation. Additionally, awareness of existing emergency resources was enhanced, while gaps in education and resources were identified for future improvement.
Conclusion: Positively engaging TM in a psychologically safe learning environment can promote increased knowledge, confidence, and readiness, which potentially creates a safer clinical environment.
Implications for nursing practice: Project results indicate in-situ educational interventions improve confidence and readiness of ambulatory care TM responding to medical emergencies. A scaled implementation across ambulatory care clinics is recommended.

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.

P057 - Development and Implementation of an Ambulatory Care Nursing Fellowship
Christine Rawlinson, MSN, RN, NPD-BC, AMB-BC

Updated: 04/22/25

Updated: 04/22/25
Outcome: 80% of participants will be able to state two tactics used in an ambulatory care nursing fellowship.
Purpose: Traditional nursing education often focuses on preparing nurses to care for patients in the acute care setting as opposed to where the majority of healthcare delivery occurs (ambulatory care). This results in a knowledge/skills gap in newly employed ambulatory care nurses. This disparity between education and employment could impact quality of care and patient outcomes. Addressing this gap through an effective ambulatory care transition-to-practice program is vital to ensuring the highest level of care.
Description: The nursing fellowship for ambulatory care nursing is designed to prepare registered nurses (RNs) with specialized skills and knowledge to excel in the ambulatory care setting. This fellowship addresses the growing need for comprehensive, patient-centered care outside of the hospital environment, focusing on chronic disease management, preventive care, and the integration of advanced technologies such as telehealth; emphasizing collaboration, top of scope work, patient education, and advocacy; and equipping participants to meet the diverse needs of patients in outpatient settings.
Nurses are grouped into bimonthly cohorts comprised of new hires in ambulatory care practice within a large academic organization. Cohorts include monthly training sessions over six months including introduction to ambulatory care; RN-led visits focusing on chronic disease management, annual wellness visits, and advanced care planning; care coordination and transition management; medication administration and safety; clinical case studies; and documentation and informatics. Each session focuses on a different topic presented by subject matter experts via a webinar format and corresponding to preassigned chapters from the AAACN Core Curriculum provided to each participant. Opportunities for open dialogue and discussion as a means of shared learning are also emphasized. Each participant is assigned an experienced mentor for 1:1 support.
Graduates of the fellowship are expected to improve patient outcomes by enhancing the efficiency of care delivery and contributing to the development of innovative care models. The fellowship prepares nurses to assume leadership roles in ambulatory care settings, driving improvements in quality and patient outcomes.
Evaluation: From July 2023 through April 2024, 15 newly hired RNs participated in the fellowship program. The closing session also included an open forum for feedback related to the fellowship. There was consensus that the planned webinar format was not conducive to the demands of the clinic's needs and schedules. Of the eight evaluation respondents, seven reported they agree or strongly agree that they are confident that what they learned in the fellowship will be useful in their job and would recommend the fellowship to other nurses.

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.

P058 - The Art of Caring: Advancing Professional Development for Medical Assistants
Joanna Clabaugh, MSN, RN

Updated: 04/22/25

Updated: 04/22/25
Purpose: Medical assistants (MA) are a rapidly growing and crucial part of the ambulatory care team. As ambulatory care practice transitions towards team-based care and patient-centered medical homes, it is imperative that investment in MA education, training, career pathways, and professional development is evaluated. Currently there is a missed opportunity for professional growth and enhancement of their skill set. Offerings for nursing professionals are readily accessible, but a deficit in opportunities for medical assistants was identified. Investing in the development of all members of the care team can help facilitate retention and job satisfaction.
Learning outcome: After completing this learning activity, the participant will be able to assess professional development strategies being used by other professionals for medical assistants and the potential of practice implementation.
Description: A needs assessment conducted in 2023 across a large urban health system with both specialty and primary care ambulatory care clinics revealed an interest in professional development and opportunities to engage in education related to the MA role. A decision was made to host the institution’s first ambulatory care medical assistant retreat in 2024. A planning committee was assembled and included ambulatory care leaders, clinical education specialists, and 22 MA stakeholders. Subcommittees were formed and included an ice-breaker workgroup, MA appreciation video team, and coordination of exhibit room, food, and prizes. Three identical four-hour offerings were planned to take place onsite to maximize the number of MAs that could attend and were free for attendees. Retreat content was identified through verbal discussions, formal needs assessment, and annual competency brainstorming. Participation from the MA committee members was vital and assisted in providing feedback on the curriculum and adding engagement activities that promoted connection. Speakers were identified from within the health system and included experts on topics from within their fields. These included the art of caring, building your career, trauma-sensitive interventions for the ambulatory care setting, de-escalation and safety in the workplace, social drivers of health, safety and emergency preparedness, and advocates of care: an MA’s perspective. An exhibit room opened during the break that offered MA specific resources such as different professional school representatives, the institution’s employee assistance program, and opportunities to connect with the speaker’s team for additional information.
Evaluation/outcome: We invited 335 MAs. Total attendance was 106 for the first two offerings, with 69 registered for the final session in December 2024. Projected total attendance of those invited is 52%. 91% affirmed that the retreat met their learning needs. Analysis of evaluation comments revealed that MAs overwhelmingly felt appreciated and valued and had an increased understanding of caring excellence, their role, and professional identity. Comments also reflected feelings of meaningful recognition and community while meeting professional development 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.

P059 - Ready, Set, Skill!! Bridging Training Gaps One Fair at a Time
Adisa Cartwright, MSN, RN, FNP-BC    |     Devie Charbonneau, BSN, RN

Updated: 04/22/25

Updated: 04/22/25
The Central Coast clinics face unique challenges when it comes to validating the skills of newly hired medical assistants (MAs). With our standard ambulatory care day 2 skills validation sessions held at the Westwood campus—approximately 170 miles from the farthest clinic and 60 miles from the closest—many new hires struggle to attend, leading to gaps in hands-on training. Additionally, finding qualified candidates from accredited programs has been an ongoing issue, with many new staff lacking experience or phlebotomy certification, further complicating their onboarding process.
The solution: a 3-day, immersive skills fair: To bridge this training gap and ensure new hires are set up for success, ambulatory care nursing has organized a specialized 3-day skills fair tailored specifically for the Central Coast clinics. This hands-on event features dedicated competency stations covering critical skills such as phlebotomy and specimen collection, medication administration, emergency management, rooming-in and vital signs, point-of-care testing, 12-lead EKG and ear lavage, oxygen administration, nebulized medication and peak flow measurement, audiometry and vision screening, and procedure tray set-up. Each station is led by experienced RN practice coordinators providing real-time guidance and feedback. This interactive format allows staff to build confidence and proficiency in a supportive environment, ensuring they meet the necessary clinical standards.
A collaborative effort supported by leadership: The skills fair is backed by clinic leadership, who recognize the need for a localized, standardized approach to training. By bringing this event directly to the Central Coast, we reduce travel barriers, accelerate onboarding, and enhance patient safety.
Looking ahead: creating a sustainable solution: Ambulatory care nursing is actively exploring long-term strategies to ensure ongoing skills validation for new hires, including leveraging technology: remote assessments and virtual skills training; dedicated support: assigning an RN practice coordinator specifically for the Central Coast region; and consistent training opportunities: offering skills fairs on a more regular basis to maintain a high level of staff competency.
Impact: empowering our staff, enhancing patient care: The Central Coast Clinics skills fair is more than just a training event; it's a commitment to support our new hires, enhance their clinical skills, and ensure the highest quality of patient care. Through this collaborative effort, we’re setting the stage for long-term improvements in staff development, competency validation, and retention across the region.

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.

P060 - Lessons Learned from an Escape Room Educational Intervention for Telephone Triage Nurses
Kathleen Ellis, PhD, RN, CCRN, CNE, Nurse Scientist, Children's Health Dallas    |     Susan Webber, MSN, RN, CPN, CEN, CPEN, CCCTM

Updated: 04/22/25

Updated: 04/22/25
Purpose: This study examined the impact of an escape room educational intervention on the knowledge, preparedness, confidence, and perceptions of teamwork of nurses working in pediatric telephone triage (PTT).
Background/significance: In PTT, nurses assess pediatric health concerns with caregivers, using guiding documents and algorithms. These services have been shown to decrease emergency department and urgent care visits. However, misinterpreted or absent data could create delayed access to care. This is enhanced in pediatric settings, where the triage nurse depends on caregivers’ interpretations. Ongoing educational efforts are vital to review good catches and missed opportunities and ensure that all team members have access to updated information. This intervention was chosen as literature showed that escape rooms are enjoyable and stimulate.
Methods: This study used a quantitative pre-/post-study on two dates in August 2024. The convenience sample was comprised of PTT nurses within a hospital. Six Likert-scale questions focused on pre- and post-intervention comparisons while four questions addressed participant satisfaction with the process. The intervention included activities surrounding an educational activity. Correct answers allowed participants to collect miniature ducks. Winning activities included getting the ducks in a row.
Results: The sample had a long tenure in nursing, with 81.57% having 15 years or more of nursing experience. Length of time working in telephone triage was fairly equally divided among groups who had worked for 0-2 years (26.32%), 3-5 years (23.68%), 6-8 years (21.05%), and 9-11 years (21.05%). Education levels were high with 86.84% of the sample holding a BSN and/or MSN degree.
A Wilcoxon signed-rank test showed that there were significant improvements in nurses’ confidence (Z = -2.308, p = 0.021), preparedness (Z = -2.232, 0.026), and knowledge (Z = -2.414, p = 0.016) after the escape room intervention. Positive trends were also observed in comfort with peers, feeling part of the team, and teamwork, although these changes were not statistically significant (p > 0.05). The median scores for all measured aspects were consistently 10 for both pre- and post-intervention.
Conclusions/implications: The sample comprised a highly experienced cadre of nursing professionals, many of whom have worked together for several years. Despite high pre-intervention levels of confidence, preparedness, and knowledge, participants showed statistically significant improvement. Questions on teamwork and collegiality also had high pre-intervention levels, but improvement on these scores lacked statistical significance.
The intervention became a competitive and engaging activity which was rated highly by participants both in the survey and in discussions about the experience. Teams were on their feet, huddled around the tables and shouting out answers.
Lessons learned from this activity included the need to design measurement strategies that did not “give away” answers to the case studies. The need to describe or select specific answers exposed learning needs that had not been previously discovered with lecture or discussion activities. This created new insight into educational needs that arose through the interactive nature of the activity.

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.

P061 - 4th Stage of Pregnancy: Optimizing Maternal Health through Nurse Navigation
Joanne Strauss, BSN, RN, CMGT-BC

Updated: 04/22/25

Updated: 04/22/25
Gap in practice: Pregnancy has been scientifically recognized as a stress test or window to future health conditions. Maternal mortality and morbidity in the United States (US) has reached alarming numbers. This has contributed to extreme racial inequities and disparities in the US. Obstetrical official visits occur every 4 weeks until 28 weeks, every 2 weeks until 36 weeks and weekly until delivery. Despite the evidence demonstrating that postpartum care helps set the stage for lifelong health and well-being, a postpartum office visit is a one-time appointment leaving gaps in practice management. The time has come to strategize efforts on the fourth stage of pregnancy, reducing disparities and improving the health of women in the community we serve.
Need for practice change: Armed with the knowledge of pregnancy as a blueprint for future health, Morristown Medical Center Women’s Health (MMC) Clinic developed a program aimed to decrease barriers and improve maternal outcomes.
Target audience: Nurses, midwives, advanced practice nurses, physicians and interdisciplinary teams working in women's health.
Practice change: Fourth stage of pregnancy nurse navigator (NN) designed to navigate postpartum patients through transitions of care during a 12-month period after delivery.
Practice change implementation method: Philanthropic funding has enabled the MMC Women’s Health Clinic to put their vision into action. In April 2023, our vision became reality by creating a part-time position for a NN. What was once a 4-6-week postpartum visit is now reimaged as continuum of care that transitions patients from pregnancy to lifelong optimization. All deliveries in the clinic are handed off to the NN. The NN assesses pregnancy complications, mental health, postpartum complications, adverse pregnancy outcomes, chronic health conditions, lactation, and birth control counseling. Referrals will be made and followed up for compliance.
Metrics: From April 2023 through August 2024, there were 1077 deliveries. Of the 1077 deliveries, 1303 (83%) referrals have been generated through nurse navigation.
Application to/implications for WH, O, or N practice: Pregnant women receiving care in the MMC clinic have NN in their fourth stage of pregnancy. Education topics and strategies are based on evidence-based literature. Clinical referrals will be recorded on a secure database and analysis conducted and verified for those women who have delivered thus far.

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.

P062 - Schedule a Video at Every Discharge (SaVED)
Noelle Frizzell, MSN, RN, NI-BC, CPHIMS    |     Gladys Juan, BSMT    |     Andrea Kossoudji, MS, MBA, RN, AMB-BC, Nurse Educator, Veterans Health Administration

Updated: 04/22/25

Updated: 04/22/25
Purpose: The Veteran Health Administration established the two-day post-discharge contact ratio in 2010, with a national goal of 75% to improve care transitions, facilitate optimal health outcomes, and reduce readmission rates. In March 2022, less than 50% of patients assigned to a VA San Diego Healthcare System primary care team being discharged from a VA medical center were being contacted within two days of discharge. The purpose of this project was to use an evidence-based approach in improving post-discharge contact and care coordination among veterans assigned to a patient-aligned care team (PACT) in the VA San Diego Healthcare System.
Description: Using the San Diego 8As evidence-based practice model, a PICOT question was developed: In patients discharged from an inpatient hospital stay in VA San Diego, do scheduled nursing video visits compared to usual care (unscheduled telephone follow-up visit) increase two-day post discharge contact in six months? A search strategy was developed using the search terms hospital readmission, “readmi*” (readmitted, readmission), follow-up, telephone, “nurse*” (nurse, nursing), telehealth, video, and discharge. 25 articles were reviewed across multiple databases including CINHAL, PubMed, and Google Scholar.
Some of the key findings indicated that process standardization and staff education can improve the rate of scheduling outpatient follow-up visits at the time of discharge and patient may prefer technology to communicate with their health care team post-discharge and their preference should be considered in post-discharge planning. A five-phase implementation design included EBP design and stakeholder engagement; establishment of infrastructure; training; execution, monitoring, and plan/do/study/act cycles; and sustainment. The phased implementation includes establishing infrastructure to generate an automatic nurse video appointment order at discharge, reconciling nurse scheduling infrastructure to support bookable appointments, and providing individualized technological support to the veteran prior to discharge. Launching in June 2020, PACT registered nurse video visits were scheduled prior to the veteran being discharged from their inpatient hospital stay. Project leads were identified to serve as the primary point of contact at each community-based outpatient clinic (CBOC) to help guide and support staff at their site. Other virtual tools such as Microsoft Teams were used to facilitate prompt communication and troubleshooting as part of the plan, do, study, act cycle.
Evaluation/outcome: In 6 months, VA San Diego Healthcare System improved the 2-day post-discharge contact ratio by 28.66%, from 49.50% to 63.68%. Patient-aligned care team registered nurses increased RN VA video connect (VVC) volume by 300%, from 66 VVCs per month to 264 VVCs per month. This evidence-based approach has demonstrated success, and facility leadership is currently in the process of updating standard operating procedures and staff competencies to support the continuation of this practice as standard work.

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.

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