NSG 601 Module 7 Discussion

What a creative tagline and association to “jammed traffic” it really makes me think about the effects of boarding in the ED “downstream”.  I do not know anything about patient flow in the ED, however I do know the effects of closing lanes on traffic and the problems that can arise. When I was a floor RN I remember having to take ED patients even when our floor was in absolute chaos; if the patient was stable he went to the floor. I can not imagine having patients, especially psychiatric, boarding in the ED. Does this impact the ED nurse to patient ratio? The ED is not designed to meet needs associated with the mentally ill, these visit occupy 42% increased provider time (Nordstrom et al., 2019). I would imagine that if any interventions help alleviate this time constraining factor, there would be 100% buy in.

Reference

Nordstrom, K., Berlin, J.S., Nash, S.S., Shah, S.B., Schmelzer, N.A., & Worley, L.L.M. (2019). Boarding of mentally ill patients in emergency department: American Psychiatric Association resource document. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health 20(5). Doi:10.5811/westjem.2019.6.42422

Mark,

NSG 601 Module 7 Discussion states that, you make a number of good points. I worked in the ED for 2 years and it is a completely different world than the floors or ICU. The organization I worked at used an acuity system, but the problems arose when this is not used correctly. At times the triage nurse would not get the complete story. This leads to acuity changes. For instance, if a patient comes in with N/V, but does not indicate they hit their head, this initiates two different treatment plans.

Boarding in the ED is a nightmare. Do you feel it has increased due to COVID or is there a pattern throughout the year/seasons. I am currently working in ICU and we have had to take floor patients to get them out of the ED and board in ICU. This creates further problems as it uses critical care resources that are now not available to the patients and hospital.

Sincerely,

Your post was well stated, clear, and concise. I agree with the barriers you have brought to the attention through this post, staff resistance, and culture change. Both are difficult to change without good leadership from the organization. In your tagline, you discuss the process of streamlining the system in the emergency department through triage. Working in the emergency department myself I fully understand overcrowding and boarding of patients as it’s a real crisis. Without control in the front (triage) then it makes it extremely difficult to manage care appropriately for patients waiting to be seen in the ED. Currently, at my assignment, the triage area has a physician that sees each patient, assesses and evaluates them, while providing treatment or orders to assist in spreading up the care of the patients. This decreases delays in care and increases patient morale all while maintaining quality patient care. Having tools and guidelines in triage is essential to perform appropriate assessments and pair the correct acuity level based on current symptoms to each patient. In one article I found they used a tool called the AIFELL score. according to NSG 601 Module 7 Discussion, this triage score considered symptoms, laboratory studies, and radiological images to identify appropriate admissions of people with COVID-19 who are critical patients (Levenfus et al., 2020). The tool allowed for a more streamlined approach as the pandemic made it difficult to know who is most appropriate for admission.

-Chelsea Kimball

References

Levenfus, I., Ullmann, E., Battegay, E., & Schuurmans, M. M. (2020). Triage tool for suspected covid-19 patients in the emergency room: Aifell score. The Brazilian Journal of Infectious Diseases, 24(5), 458–461.