Medicine and Health Sciences Commons^™

Human Trafficking And Resources Provision In The Ed, Kathryn Patrick

Doctor of Nursing Practice Projects

Human trafficking is both a human rights violation and a national health crisis. Despite nearly 165,000 identified cases in the United States since 2007, studies hypothesize that many more victims remain undetected despite up to 88% of trafficked persons interacting with the healthcare system during the time they are being trafficked. The lack of identification of these victims has often been attributed to healthcare providers' lack of knowledge regarding human trafficking indicators and lack of confidence in how to address trafficking situations when they are encountered. Emergency department care providers of a 500-bed central Illinois hospital received education and resource …

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 …

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 …

Perception Of Pediatric Readiness Across A Health System's Emergency Departments, Rebekah L. Sabo

Doctoral Dissertations

The recent pandemic and pediatric respiratory syncytial virus surge have reinvigorated pediatric care readiness conversations. National strategies and associations exist to guide health systems in improving the quality of emergency care offered to pediatric populations by first assessing readiness for care. These research strategies center on survey implementation and staff engagement in general emergency departments with the goal to improve staff readiness to care for pediatric patients that may present for treatment. What impact would developing a consolidated pediatric readiness program that includes: pediatric emergency care coordinator designation for each emergency department, pediatric readiness education and committee engagement have on …

Empowering Caregivers In The Prevention Of Clinical Delirium For At Risk Older Adults Boarding In The Emergency Department Setting, Danielle Brewer

DNP Projects

Background: Emergency Department (ED) overcrowding is a global healthcare crisis documented in the literature for more than a decade, impacting patient outcomes and resource availability. While awaiting delayed transfer to an inpatient room, older adults in the ED remain vulnerable to developing acute delirium. Boarding potentiates the risk for worsening health outcomes, which are further compounded by delirium. Scarcity of resources and time constraints delay delirium detection and increase risk for down-stream hospital-acquired complications, higher cost, and prolonged length of stay. Current ED models do not prioritize caregiver partnership or involvement in delirium-conscious care, which is a holistic approach to …

Reducing Emergency Department Visits For Children With Autism Spectrum Disorder: Nurse-Led Home Interventions, Teri Nguyen

Nursing | Senior Theses

In the realm of pediatric healthcare, children diagnosed with Autism Spectrum Disorder (ASD) face unique challenges alongside their caregivers. Caregivers face challenges in accessing appropriate support and resources to effectively address the needs of children with ASD. Children with ASD struggle with sensory sensitivities, impaired safety awareness, and difficulties perceiving potential dangers which put them at greater risk for injuries. As a result, children with autism have higher rates of emergency department visits compared to their neurotypical peers. This research aims to assess the effectiveness of nurse-led home injury prevention and education in reducing emergency department visits for children with …

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 …

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. …

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 …

Utilizing A Validated Screening Tool And Treatment Protocol For Managing Agitation And Violence In A Psychiatric Emergency Services Unit, Zarah Ashcroft

Doctor of Nursing Practice

Background and Significance. Agitation is a significant concern in psychiatric units. If not detected early, agitated individuals are at high risk for becoming aggressive and violent, potentially causing harm to themselves, hospital staff, and property. The Psychiatric Emergency Services unit receives agitated and violent patients with psychiatric illnesses and substance use disorders. Purpose/Goal/Objectives. This quality improvement project aimed to implement a treatment protocol using the Broset Violence Checklist (BVC) to promote the early identification and management of potential for patient violence and aggression. Methods/Key Activities. Staff education for the nurses and providers on assessing patients at risk for aggression and …

Emergency Department Patient Navigator Post Chest Pain Diagnosis Discharge, Nancy Simoes

Seton Hall University Dissertations and Theses (ETDs)

Abstract The most common complaint seen in the Emergency Department, along with abdominal pain, is nonspecific chest pain. Often, these complaints cause prolonged lengths of stay in the ED, followed by hospital admissions and subsequent readmissions for various reasons. When thinking about these various reasons, the question for prevention of readmission comes to mind. What could we do as a department to keep patients from continuously using the Emergency Department as a primary point of care instead of outpatient facilities when necessary? Project Aim: The purpose of this quality improvement project was to initiate the need for a patient navigator …

Emergency Department Registered Nurses’ Perceptions Of Substance Use Disorders And Supervised Consumption Sites, Aleksandra Ilievska

Electronic Theses and Dissertations

Background: Canada is facing increased drug-related harms; thus, a stronger emphasis has been placed on harm reduction strategies such as supervised consumption sites (SCSs). There is a lack of literature on emergency department (ED) registered nurses’ (RNs) perceptions of SCSs and substance use disorders (SUDs), especially in small to mid-sized Canadian cities.

Purpose: This study aimed to determine ED RNs’ perceptions of SUDs and SCSs in Southwestern Ontario hospitals.

Methods: A 27-question survey was sent to RNs currently working in EDs in Southwestern Ontario using an online Qualtrics® link. The research explored ED RNs’ perception of SCSs and SUDs.

Results: …

Implementation Of A Patient Care Specialist Role To Enhance The Patient Experience In A Pediatric Emergency Department, Jillian Brodeur

Doctor of Nursing Practice Projects

Background: Patient-centered care (PCC) has been an emerging trend in healthcare for the past two decades (Walsh et al., 2022). PCC and the patient experience have become essential measures of the quality of care provided and are linked to reimbursement dollars and improved patient outcomes (Rapport et al., 2019).

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to improve the patient experience in the Emergency Department (ED) of a metropolitan hospital. The DNP project focused on the benefit of a patient advocate in the ED to improve the patient experience. The project sought to improve …

Improving Early Sepsis Recognition And Treatment By Utilizing The Surviving Sepsis Campaign In Emergency Department Patients, Rebecca Smith

Doctor of Nursing Practice Projects

Background: Sepsis is a physical reaction to infection that can cause bodily injury, organ deterioration, and death (Sepsis Alliance, 2022). Early sepsis identification and intervention requires staff engagement in quick recognition and implementation of care (Jorgensen, 2019). Septic patients require prompt initiation of intravenous fluids, hemodynamic observation, and appropriate laboratory testing (Evans & Rhodes, 2021). Rapid detection of sepsis can prevent patients from progressing to severe sepsis and septic shock, increasing the risk of mortality (Jorgensen, 2019). As a result of the high mortality rates and complications associated with this health disparity, evidenced-based care bundles were developed to improve care …

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, 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, 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%. …

Health Literacy And The Feasibility Of Using Video-Based Education In The Emergency Department, Jenifer Carvell

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: The Department of Health and Human Services (HHS) defines health literacy as the degree to which an individual has the capacity to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. In the emergency department (ED), it is estimated that the prevalence of inadequate health literacy can reach as high as 88 percent. There is a need to implement literacy-sensitive interventions in the ED. Purpose: The purpose of this project was to engineer an intervention that explored the feasibility of the use of personal technology to deliver video-based education to adult …

New York State Emergency Department Assessment Treatment And Referral Of Individuals Presenting To The Emergency Department With Opioid Use Disorder, Macia Victoria Drummond

Theses & Dissertations

Opioid dependence and addiction are classified as severe medical conditions that cause adverse effects on the individual, their family, and society as a whole. The increasing number of opioid overdose cases and deaths has posed a significant challenge for emergency departments (EDs) as they play a crucial role in providing immediate medical attention to patients with opioid use disorder (OUD). The consequences of OUD are alarming, with high morbidity and mortality rates. The purpose of this study was to examine the policies, practices, and barriers to adherence to nationally recognized clinical best practices for treating patients with OUD in New …

Implementation Of A Code Lobby Surge And The Impact On Left Without Being Seen Rates, Nicole Plouffe

Student Scholarly Projects

Practice Problem: Crowding of emergency departments contribute to higher-than-average left without being seen (LWBS) rates. LWBS patients pose risks to the hospital as well as to one’s own health.

PICOT: The PICOT question that guided this project was in a pediatric emergency department (P), does implementation of a “Code Lobby Surge” (I), compared to standard care (C), decrease left without being seen rates (O) within eight weeks (T)?

Evidence: Surge interventions and decreasing the visual of crowding have shown to decrease LWBS rates.

Intervention: “Code Lobby Surge” was implemented to decrease LWBS rates and improve throughput within the …

Why Doesn't She Just Leave? Improving Identification And Response To Victims Of Intimate Partner Violence In The Emergency Room, Elizabeth Berry

Doctor of Nursing Practice Projects

The purpose of this project was to improve identification and response to victims of intimate partner violence (IPV) presenting to the emergency department. Project participants completed a pre-education questionnaire prior to the project leader providing intimate partner violence educational materials and a presentation entitled Recognizing and Responding to Victims of Intimate Partner Violence in the Emergency Room. The project participants then completed a mirrored post-education questionnaire. Evaluation of the project included a comparison of the participant's responses to the mirrored questionnaires. Project participants reported an increase in the:

• recognition of the prevalence of intimate partner violence among their patients, …

Staff Perceptions Of Workplace Violence In The Emergency Department; Increasing Safety Awareness And Education, Marissa Hibbs

DNP Projects

Purpose: The purpose of this project was to evaluate nursing staff perceptions of safety and workplace violence and increase safety awareness and knowledge in the emergency department of a level 1 trauma center.

Methods: This study was a single site project that used a descriptive non-experimental survey design to evaluate staff perceptions on workplace violence and safety before and after educational intervention. The study was broken down into three parts. After obtaining IRB approval, an invitation to participate in the pre-survey was distributed via email in a private electronic unit-based list server. Then an educational intervention on workplace safety and …

Improving Handoff Communication In The Emergency Department, Amy Shepherd

Doctor of Nursing Practice Projects

Ineffective handoff communication has been recognized for years as a practice issue and is the most frequently reported cause of sentinel events in U.S. hospitals (Dufault et al., 2010) and responsible, at least in part, for 30% of all malpractice claims (Fucik, 2019). The development of standardized tools has been identified as a key component to improving handover practice. For this project, a standardized SBAR tool was modified for a local emergency department. The intervention was a process change in the emergency department to utilize an SBAR tool during handoff reports. The project was implemented by educating staff on the …

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 …

Contributing Factors And Solutions For Inappropriate Use Of The Emergency Department, Lesia M. Kozych

Honors Capstones

Emergency departments are overwhelmed with the sheer quantity of patients, many of which are there for the non-emergent reasons. The purpose of this project is to identify factors that contribute to emergency department (ED) misuse, initiatives or programs that have been successful in decreasing ED misuse, and ED personnel’s opinions on contributing factors and potential solutions. A literature review followed by semi-structured interviews of ED personnel produced the necessary information. Common themes were drawn from participant responses in the interview portion. A major barrier to appropriate use of the emergency department is access to primary care. Others include: lack of …

A Bedside Handoff Tool To Enhance Fall Safety Measures In The Emergency Department, Isha Adora Godbold

Doctor of Nursing Practice Scholarly Projects

Problem Statement: The Emergency Department (ED) is a fast-paced environment where the risk of communication failure enhances due to the variation in patient acuity, variety of shift options, and constant interruptions (White- Trevino & Dearmon, 2018). Ineffective communication can lead to increased adverse events, medical errors, and poorer patient health outcomes (Campbell & Dontje, 2019). Additionally, medical errors, such as falls, are more likely to occur during handoff when nurses change shifts (Campbell & Dontje, 2019). The most reoccurring medical error in the ED is patient falls.

Purpose: This quality improvement project aims to introduce a structured handoff rounding

tool, …

Advancing Treatment For Opioid Use Disorder In A Rural Emergency Department, Jill M. Wabbel

Doctor of Nursing Practice (DNP) Projects

Background: The opioid epidemic escalated in the United States due to the availability of prescription opioids, heroin, and synthetic opioids like fentanyl. Unfortunately, access to treatment is not always accessible, especially in rural communities with limited resources.

Local Problem: Tehama County is a rural county in northern California with limited access to treatment for opioid use disorder. The local Emergency Department (ED) and primary care-based Medication-Assisted Treatment (MAT) clinic collaborated to increase access. However, services remain under-actualized due to limited understanding of MAT best practices, stigma related to substance use within the ED culture, and poor articulation between the ED …