Impact of a standardized admissions process using a nurse intermediary

Abstract

Objective: Transitions of care, including those between the Emergency Department (ED) and Internal Medicine (IM) for hospital admissions are complicated, variable processes that impact efficiency and patient safety. At our institution, a new, standardized admissions process that involved a nurse coordinator intermediary who served a dual role of facilitating admissions and overseeing bed board was implemented in July 2017. We aimed to evaluate the impact of the new process on ED throughput and safety outcomes of admitted patients.
Methods: A retrospective analysis of the admissions process for patients at an urban, academic ED was conducted over a 4-month period preceding and following process implementation. ED metrics, including admission decision to ED departure time, were reviewed. In addition, the number of admitted patients upgraded to the intensive care unit (ICU) via a rapid response team (RRT-ICU) within 24 hours of admission and direct physician-physician handoffs were analyzed via surveys of both IM and EM physicians.
Results: A total of 1,109 admissions were reviewed. The new admissions process resulted in a statistically significant decrease in boarding times for admitted ED patients (p = .03). The number of RRT-ICUs within 24 hours of admission did not change as a result of the intervention (p = .5). Direct physician handoffs increased, but not significantly, according to surveys of IM (p = .39) and EM physicians (p = .34).
Conclusions: The implementation of a standardized admissions process utilizing a nurse intermediary improved provider communication and ED throughput without negatively impacting patient safety.