A Nurse-Led QI Project to Reduce ED to ICU Transition Time

Countless studies conclude that the longer an admitted patient boards in an emergency department (ED) the greater the risk for negative outcomes such as falls and hospital-acquired conditions. ED patients waiting for admission to the intensive care unit (ICU) may be at the greatest risk, as they are categorized as critical.

Transporting critical patients from the ED to the ICU requires coordination of multiple clinicians from both units, which can lead to delays. Leading and managing these coordination efforts is a challenge. However we are optimistic as small tests of change have led us to advancements in the timeliness of ICU admissions and improvements in quality and safety.

-Jonathan Nover, MBA RN, senior director of nursing, Mount Sinai Queens

The Project

Geneline Barayuga, MSN RN

The ED and ICU teams at Mount Sinai Queens, a 165-bed hospital with 70,000 annual ED visits in Queens, New York, performed a quality improvement (QI) project by developing a collaborative approach between the ICU and ED charge nurses to reduce the median […]

2023-12-11T10:17:23-05:00December 11th, 2023|Nursing, Quality improvement|0 Comments
Read More

Improving the Discovery and Care of Pressure Injuries in the Emergency Department

Jonathan Nover, MBA, RN

The problem.

Hospital-acquired conditions, particularly pressure injuries (PIs), increased at alarming rates during the COVID-19 pandemic. Hospital isolation precautions and infection prevention practices limited clinician time at the bedside. How does a nurse regularly turn and position a patient if they are unable to enter the room as often as they did prior to the pandemic? In addition, hospitals often operated with high percentages of their workforce out sick.

While Covid may be less of a threat by now, the number of patients admitted to EDs continues to increase while nurse staffing shortages intensify the pressure on nurses to maintain patient safety standards. With patient boarding in EDs becoming more common, the risk of hospital-acquired PIs grows as well, even in the ED. Traditional ED care focuses on rapid screening, assessment, and stabilization, followed by discharge or admission. But the reality is that medical–surgical inpatient care has become more necessary in the ED.

A central element of nursing care is the identification of PIs upon entry to the hospital, PI prevention, and care of existing PIs. Patients who are boarded in the ED, particularly older patient populations with underlying diseases and long length of stays, are at especially high risk for pressure ulcers […]

2022-10-27T11:03:41-04:00October 27th, 2022|Nursing, patient safety|0 Comments
Read More

AJN in May: Night-Shift Naps, Intrathecal Cancer Pain Relief, Teaching Nurses to Write, More

On this month’s cover is A Maid Asleep (1656–57) by the Dutch master Johannes Vermeer. We chose this painting to call attention to the issue of sleepiness in nurses who work the night shift, which is explored in this month’s Original Research article.

On-the-job sleepiness among nurses can increase the risk of patient care errors, job-related injuries, and long-term health problems.

For night-shift nurses, one potential solution is being allowed to take brief naps during a shift, which the American Nurses Association recommends as an evidence-based countermeasure to fatigue. But nurses may face barriers to doing so, including a lack of formal breaks on the unit and concerns about impeding the quality of nursing care. To learn about a project that explored those barriers and attempted to implement night-shift naps, read “Napping on the Night Shift: A Two-Hospital Implementation Project.”

Some other articles of note in the May issue:

CE Feature: “Intrathecal Pumps for Managing Cancer Pain.” Among patients with cancer, moderate to severe pain is prevalent and can be refractory even with the use of systemic opioids, which may cause adverse effects that are difficult to manage at the doses required to control pain. When delivered intrathecally, however, opioids and adjuvant analgesics may provide greater pain relief at dramatically lower doses and with fewer adverse effects. This article provides an overview of intrathecal pump therapy, including its benefits and potential risks and complications; the medications that can be delivered intrathecally; and the nursing care […]

2016-11-21T13:01:16-05:00April 29th, 2016|Nursing, nursing perspective, nursing research|0 Comments
Read More

Blind Spot – At the Intersection of Mother and Nurse

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

Being a nurse has changed my reactions to situations at home. For one thing, I don’t get overexcited about non-life-threatening medical problems. I can hardly stand the thought of going to an emergency room (Steri-Strips and ice are my usual “go-to” treatment plans). I’d like to blame this on working in a trauma center—it makes sense that seeing catastrophic injuries every day tends to make less severe injuries look insignificant—but I’m not sure that completely excuses my recent diagnostic error.

My son, who’s 12, came home from school last week complaining that his hand was sore. He’d hit a wall in gym, he said, but it was a padded wall, and he hadn’t hit it very hard. Still, he was absolutely certain that, at the very least, he’d dislocated something, and that, most likely, he’d broken his hand.

To my defense, he has a history of overdramatizing situations, and I took his self-assessment with a grain of salt. Although the side of his hand was slightly swollen, nothing was bruised, and everything seemed to be moving all right.

We iced it, of course, and although hand pain didn’t seem to interfere with his usual activities, he proceeded to tell anyone who would listen that he’d broken his hand.

“Stop saying that!” I told him. […]

2016-11-21T13:11:48-05:00October 6th, 2011|career, Nursing, nursing perspective|7 Comments
Read More

Caring for Suicidal Children in the ED

By Sylvia Foley, AJN senior editor

Suicidal children and adolescents are often first seen in EDs. At Children’s Hospital Boston (CHB) recently, a boy we’ll call J.J. was one of them. Still in elementary school, he had just started a new school year. J.J. has Asperger’s syndrome (a disorder on the autism spectrum), and new situations are difficult for him. His classmates were teasing him, and it was escalating: one boy reportedly threatened to kill J.J. for being “weird.” Despite efforts by J.J.’s parents and the school to address the situation, J.J. became increasingly depressed and fearful. As September CE authors Alexis Schmid and colleagues explain,

On the morning of the ED visit, as the family members were starting their day, J.J. had gone into the kitchen, found a butcher knife, and held it to his throat. His mother walked in and saw him. Although J.J. willingly surrendered the knife to her, she said she was “rattled to the core.”

Schmid was the ED nurse on J.J.’s case that day (all three authors work at CHB). In “Care of the Suicidal Pediatric Patient in the ED: A Case Study,” the authors describe the course of J.J.’s care and what they did to keep J.J., his […]

2016-11-21T13:12:00-05:00September 1st, 2011|Nursing|0 Comments
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
Go to Top