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 boarding time […]

2023-12-11T10:17:23-05:00December 11th, 2023|Nursing, Quality improvement|0 Comments
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Military Environmental Exposures: Recommended Reading in AJN’s November Issue

The November issue of AJN is now live.

What should nurses know about caring for people who have been exposed to potentially harmful agents—such as air pollutants, chemicals, radiation, warfare agents, and materials containing asbestos and lead—during military service? Read “Military Environmental Exposures” to find out.

Our November CE article, “Recognizing Transfusion-Associated Circulatory Overload,” reviews the most current definitions of this adverse transfusion reaction and outlines its characteristics and management.

“What Health Care Staff Who Experienced Assisted Patient Falls Can Teach Us: Implications for Fall and Fall Injury Risk,” presents qualitative findings from a QI project aimed at improving guidance for staff on the risks of assisting falling patients.

“Nursing Research, Step by Step: Sample Size Planning in Quantitative Nursing Research,” one in a series on clinical research by nurses, describes how to determine an appropriate sample size for a quantitative research project, and introduces the concepts of error, power, and effect size.

In “Optimizing Blood Culture Collection Volumes,” the authors discuss a QI project they conducted to understand the causes of underfilled and overfilled blood cultures obtained by nurses and PCTs and to reduce their incidence.

See also the extensive […]

2023-10-26T11:59:45-04:00October 26th, 2023|Nursing|0 Comments
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Recommended Reading from the August Issue of AJN

The August issue of AJN is now live.

“Nursing Care for Patients After Ostomy Surgery,” a CE feature, details the basics of pre- and postoperative care and patient education for colostomy and ileostomy—two of the most common types of ostomy surgery.

This month’s Original Research article is on nurses’ self-reported QI engagement and competence. Also see “Cultivating Quality: Reducing Tubing and Device Connections” to learn about a nurse-led QI project that explored misconnection prevention strategies.

“Fostering Race-Based Conversations in Nursing,” our latest Focus on DEI column, discusses ways to address racism and promote cultural competence.

AJN Reports examines the unintended consequences of online health care portals, noting that:

Although patient portals are designed to help with the management of personal health information, their proliferation may also be creating barriers to care for some people.

See also the extensive health care news sections, the Journal Watch and Drug Watch sections, a new installment in our series on palliative nursing, and a Reflections essay on how a school nurse compassionately cared for the author when she became pregnant at age 15—and whose kindness inspired the author to eventually become a family […]

2023-07-27T10:05:09-04:00July 27th, 2023|Nursing|0 Comments
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QR Codes for Rapid Responses: Improved Clinical Operations and DEI Insight

Improving data collection of RRTs for quality improvement

The method we use to track rapid response team (RRT) data has evolved on our health campus at Mount Sinai Queens. Just a few years ago we were using paper logs; now we use electronic logs accessed by a QR code. The goal initially has been to become paperless and collect data to analyze our rapid responses for clinical insight. The greater data collection with the QR code process has in turn allowed for analysis, including a closer examination of diversity, equity, and inclusion (DEI) variables. 

About our rapid response team

Our RRT consists of the ICU charge nurse, ICU attending, respiratory therapist, and the nurse manager or the evening/night nursing administrator. They are called upon when there is a significant change in a patient’s condition that requires critical care expertise at the bedside. After hearing the overhead call for a rapid response, the responding ICU RN scans the RRT QR code using a smart phone. The QR code is displayed within the ICU nurses station for easy access. Depending on the type of rapid response, the responding RN can enter data into the RRT electronic log as care progresses and/or at the conclusion of the response.

2023-06-14T17:12:55-04:00June 14th, 2023|equity, Nursing, Quality improvement, Technology|0 Comments
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Black Boxes in the Operating Room: Improving Quality of Care and Patient Safety

What’s covered in this post?

  • Black boxes record video, audio, and data from multiple sources in the operating room (OR), such as cameras, microphones, patient monitoring equipment, and medical devices.
  • By offering transparency on the multiple simultaneous processes in the OR, black box data can be used to improve safety and efficiency, train staff, and onboard new nurses.
  • The data can be used for retrospective analysis of specific events or aggregate analysis to detect patterns and variations in practice over time.
  • Black box data has been used to improve and standardize OR processes such as handling tissue samples, handoff communication during shift changes, and pre-surgical patient positioning.
  • The data is de-identified and is normally deleted within 30 days.
  • Finding what went right and learning from it is the goal, not pointing fingers.

Figures in the OR as recorded and de-identified by an OR Black Box. Image courtesy Surgical Safety Technologies.

Rebecca McKenzie, DNP, MBA, MSN, RN, assistant vice president of perioperative services at Duke University Hospital, recently spoke with AJN about her hospital’s use of black boxes in operating rooms (ORs) to standardize key processes to improve safety and efficiency, train current […]

2023-05-26T15:01:50-04:00May 5th, 2023|Nursing, patient safety, Quality improvement, Technology|1 Comment
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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.
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