At left, Miriam Carasa, RN, CNE, patient care services, nursing, shows Nurse.coms Eileen P. Williamson, RN, senior vice president and CNE, the breakthrough information board, which showcases various rapid improvement events and value stream teams that are successfully eliminating waste and improving clinical outcomes at North Brooklyn Health Network.
During the past few years, RNs in the 74-bed ED at Woodhull Medical Center, North Brooklyn Health Network, have successfully implemented nursing initiatives to ensure patient safety and improve patient outcomes and satisfaction.
With the development of an RN “greeter” role and reception area, the facility has reduced its door-to-ECG time for cardiac patients and door-to-CT scan time for stroke patients and ensured patients who are critically ill or are in mental health crisis are placed immediately in a safe environment, said Michael E. Impollonia, RN, MSN, CSRN, NE-BC, assistant director, nursing education and research. Now, the door-to-ECG time is 10 minutes, and the door-to-CT scan time is less than 25 minutes.
After the nurse and unit clerk welcome patients and complete mini-registrations at the reception area, the RN performs pretriage assessments and directs patients to the appropriate area of care, depending on each patients condition and needs. The RN provides information and guidance and answers any concerns or questions. A camera at the reception desk gives the nurse another way to visually monitor patients who are waiting.
A place to go
Administration and staff identified a need to provide a safe place for intoxicated patients to receive care and a need to remove potentially violent patients from the general ED population. As a result, they created a dedicated, eight-bed medical management unit that is part of, but separated from, the general ED.
When patients are admitted directly to the medical management unit, they are assessed for withdrawal symptoms and given a mental health screening. “Once the patients medical and psychosocial needs have been established, our nurses can monitor them closely and provide counselors for our chemical dependency and mental health services,” said Jonathan Nover, RN, assistant director of nursing, ED.
RNs are trained to use the Clinical Institute Withdrawal Assessment for Alcohol, the Clinical Institute Narcotic Assessment Scale, the CAGE Substance Abuse Screening Tool as well as the SAD PERSONS Scale for suicide screening.
“The implementation of the medical management unit has resulted in reductions in falls and elopements, as well as a reduction in the number of patients experiencing severe withdrawal symptoms,” said Miriam Carasa, RN, EdD, NE-BC, who serves as CNE, patient care services, nursing.
Another person to help
With the goal of improving patient satisfaction in the ED, staff and administration have initiated an ED client navigator role in the past year. Navigators, who are trained in collaboration with the patient relations department, must speak Spanish or Polish, in addition to English.
The navigators make comfort rounds and act as patient advocates by listening to patient and family concerns and expressing those concerns back to the medical team. There now are two or three navigators in a 16-hour period. Though the navigator is a non-nursing role, nurses feel they are a worthwhile resource and are part of the ED team, Nover said.
Janice Petrella Lynch, RN, MSN, is a regional nurse executive.