Medicine and Health Sciences Commons^™

Refining Triage Documentation Practices In A Metropolitan Emergency Department, Jack A. Moody

Master's Projects and Capstones

Problem California ranks ninth nationwide for its lengthy emergency department wait times, presenting a pressing challenge for healthcare facilities. Context This quality improvement project, set in the emergency department of a large urban hospital in the Bay Area, aimed to address this issue by targeting workflow efficiency through the reduction of triage times. Intervention The intervention centered on implementing changes to the triage documentation, informed by staff feedback obtained through an opinion survey. Proposed modifications included the elimination of redundant questions, consolidation of related categories, and a logical reorganization of triage topics. Measures Key measures utilized in the project included …

Optimization Of Triage Documentation In A Large Urban Emergency Department, Monica Reynoso-Prieto

Master's Projects and Capstones

Problem California ranks ninth nationwide in terms of longest emergency department wait times. The project aims to reduce patient triage times by refining the workflow of triage documentation, achieved through strategic rearrangement of triage documentation questions. Context This quality improvement project took place in the emergency department of a large urban Bay Area hospital. Intervention The intervention was implementation of changes to the triage documentation based on staff feedback from an opinion survey, such as: elimination of redundant questions, consolidation of related categories, and logical reorganization of triage topics. Measures Measures used in the project were triage times and pre …

Improving Triage Accuracy In The Emergency Department, Catriona E. Clohessy

Master's Projects and Capstones

Problem: Hospital Z’s emergency department was experiencing a triage inaccuracy rate that exceeded the accepted national benchmark of 10%. This quality improvement project aimed to reduce triage inaccuracy to less than 10% in the emergency department at Hospital Z, through improved education and availability of supplemental reference materials.

Context: This quality improvement project was conducted in a 40 bed emergency department at Hospital Z. This microsystem serves a diverse patient population from the surrounding community that experience a variety of conditions requiring emergency medical intervention.

Interventions: Clinical Nurse Leader nursing students partnered with unit leadership to create a new ESI …

Improving Triage Accuracy In The Emergency Department, Vince Harrington

Master's Projects and Capstones

Problem: Mistriage was occurring at higher than acceptable rates. In turn, this caused poor staffing levels and patient outcomes. This project seeks to improve triage accuracy according to the Emergency Nurses Association’s (ENA) Emergency Severity Index (ESI) algorithm.

Context: The Emergency Department in a prominent bay area hospital that was experiencing high rates of mistriage.

Interventions: The staff nurses were required to attend a retraining on the Emergency Nurses Association (ENA) Emergency Severity Index (ESI) algorithm. Following the retraining, a follow up online exam with sample patients must be passed at 100%. Furthermore, badge buddies containing the ESI algorithm will …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Efrain Perez Trujillo

Master's Projects and Capstones

Problem: This quality improvement (QI) project aims to optimize early sepsis management and sepsis bundle compliance among Emergency Department (ED) registered nurses in order to reduce the risk of sepsis-related deaths and associated hospital length of stay.

Context: Clinical Nurse Leader (CNL) students conducted a microsystem assessment on the ED at Hospital A, located within the greater San Francisco Bay Area. This microsystem, equipped with 115 nurses and 44 rooms, consists of an acuity of care for urgent to life-threatening medical conditions, including sepsis.

Intervention: Following time constraints, and limitations, implementation of an intervention was not feasible; however, CNL students …

Improving Triage Accuracy In The Emergency Department, Maia E. Baglin

Master's Projects and Capstones

A Northern California emergency department (ED) faced increased triage inaccuracy. An analysis of 400 random ED visits from January to April 2023 discovered a 23% mistriage rate, with under- and over-triage rates at 16.25% and 6.75%, respectively. Mistriage creates an imbalance in unit acuity, leading to inappropriate staffing levels. Potential breaks in the triage process, include inaccurate triaging by the screener or triage nurses, as well as delays in the providers inputting initial orders, leaving patients waiting without appropriate care orders. An educational training focusing on the updated Emergency Nurses Association Emergency Severity Index (ESI) algorithm version 5 was mandated. …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Spencer Forest

Master's Projects and Capstones

Problem: This quality improvement project aims to increase SEP-1 sepsis bundle compliance among nursing staff at a 16-bed emergency department through targeted continual staff education on sepsis screening and best practices. Currently, the unit is experiencing cases of sepsis fallout and is not meeting the 90% threshold on three treatment metrics as defined by the institutional sepsis bundle time goals. Bundle compliance that adheres to the time goals decreases incidences of sepsis fallout and overall days in the hospital, while increasing positive patient health outcomes.

Context: A microsystem assessment was completed along with a staff gap survey to determine areas …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Gregory James Trevino

Master's Projects and Capstones

Problem: Providing high-quality sepsis care in a San Francisco Bay Area emergency department (ED) is an organizational priority, however Centers for Medicare & Medicaid Service (CMS) SEP-1 sepsis bundle compliance has decreased to an average of 79% compliance since October of 2022. It was revealed that CMS SEP-1 sepsis bundle compliance issues have resulted in increased patient fallouts.

Context: A microsystem assessment was conducted by the quality improvement team to help identify gaps in practice. After an assessment survey of nursing staff, it was revealed that barriers such as physician order sets, lack of communication, lack of staffing during peak …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Leman E. Bush

Master's Projects and Capstones

Abstract

Problem: Sepsis is a life-threatening infection that needs immediate treatment. The ED uses sepsis bundle protocols to treat sepsis but the compliance rates for the order sets are below the institution’s guidelines.

Context: A Centers for Medicare and Medicaid Services (CMS) instituted a sepsis performance measure bundle in 2015 called (SEP-1) to promote cost-effective, high-quality care for septic patients admitted to the Emergency Department (ED) (Wang et al., 2020). The ED in a chosen San Francisco, CA acute care hospital has been experiencing unsteady sepsis bundle compliance rates. Sepsis is caught by 1.7 million American adults per year …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Shirley Chen

Master's Projects and Capstones

Problem: This project was implemented to decrease patient fallout rates through timely compliance with sepsis management according to the SEP-1 bundle. The SEP-1 bundle is already implemented in the emergency department. However, a microsystem assessment indicated barriers are preventing the achievement of the SEP-1 bundle milestones.

Context: This 16-bed emergency department (ED) at an urban Bay Area hospital provides 24-hour emergency services to individuals who suffer from medical injuries, accidents, and other serious health conditions. A random audit of the electronic health system (EHS) revealed that this emergency department consistently fails to meet the sepsis management time goals by 90%. …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Stop The Bleed And Seize Control: The Use Of Simulation And Video Modules In Educating Emergency Department Staff Regarding Maternal Hypertension And Hemorrhage, Jared Maxwell Talsky

Master's Projects and Capstones

In order to address shortcomings of the health care system within the United States surrounding the early recognition and response to preeclampsia (PreE) and postpartum hemorrhage (PPH) emergencies The Joint Commission (TJC) revised the accreditation requirements regarding implementing yearly maternal hypertension and hemorrhage simulation scenarios in emergency departments. A Quality improvement team of Clinical Nurse Leader (CNL) students at University of San Francisco, working alongside the emergency department and labor and delivery department nurse educators assisted a dual hospital system in the Bay Area of California to develop and implement training materials and simulations for the hospital system’s Emergency Department …

Stop The Bleed And Seize Control: The Use Of Simulation And Video Modules In Educating Emergency Department Staff Regarding Maternal Hypertension And Hemorrhage, Yvonne Oliva

Master's Projects and Capstones

Problem: This quality improvement project aims at Hospital X meeting the new Joint Commission (JC) provisional deadline through the implementation of simulation training and video development as a way of educating emergency department (ED) staff in recognizing and treating preeclampsia (PreE) and postpartum hemorrhage (PPH).

Context: This quality improvement project utilizes evidence-based practice, California Maternal Quality Care Collaborative (CMQCC) toolkits, and JC standards to educate ED staff on worsening cases of maternal morbidity and mortality nationwide. Research shows that early recognition and prevention of maternal hemorrhage and preeclamptic emergencies has the highest probability of decreasing maternal complications in the ED. …

Pregnancy Loss In The Emergency Department, Gudrun Reiterhiltebrand

Master's Projects and Capstones

Abstract

The aim of this project is to improve the care for patients experiencing pregnancy loss in the emergency department (ED). Objectives are to enhance understanding of staff about the patients’ experience and their knowledge on how to best care for emotional needs, thus improving quality of patient care, work satisfaction, knowledge, confidence and comfort levels, while decreasing experienced stress. The project was implemented in a midsized community hospital with 117 beds, which discharged 74 patients with “interrupted pregnancies” over the previous year from the ED. The project was directed toward nurses, doctors, care partners, chaplains, and social workers. The …

Debriefing In The Emergency Department, Alyssa Johnson

Master's Projects and Capstones

Emergency Department (ED) staff are repeatedly exposed to high stress situations and as a result suffer from compassion fatigue, secondary traumatic stress, symptoms of post-traumatic stress disorder, burnout and high turnover rates. Staff turnover is costly to the health system in the form of training new staff and potential poor patient outcomes due to under staffing or inexperience of staff. Based on a survey about debriefing, Level 1 Adult and Pediatric Emergency Department staff reported 81% felt there was inadequate support for critically stressful events that occur. Debriefing was identified by 75% of the staff as an option for support. …