Moving patients quickly through the emergency department and into inpatient rooms lead to better outcomes, higher patient satisfaction, and expert care from units that specialize in their diagnoses. Yet ED boarding remains a challenge across the country.
Kristen Stacy, MSN, RN, CEN, CPEN, NPD-BC
“We all see it and feel it, but the literature very strongly supports that boarding is not the best for patient outcomes,” said Kristen Stacy, MSN, RN, CEN, CPEN, NPD-BC, an emergency services clinical nurse specialist for UK HealthCare in Lexington, Kentucky. Stacy will take on this issue as one of the presenters for the session “Bored with Boarding? Innovations in the Nursing Handoff,” which takes place Sept. 6 from 4:30-5 p.m. in Titian 2301. It will cover the types of boarding and the impact that boarding has on patients and ED staff, as well as share how the ED at UK HealthCare successfully addressed the problem.
To improve this issue and reduce the amount of time patients spend in the ED, a nursing workgroup at UK HealthCare worked with health science engineers to identify delays in the admitting process and implement nurse-driven improvements that reduced transfer time from 148 minutes to 60 minutes from July 2021 to August 2023.
“We made very small tweaks in the process, and it made a huge impact on the time patients spent just waiting to be transferred to a room that was clean and ready,” said Stacy.
Those numbers have been sustained, too.
“Our patient volume spiked, and our time still continued to go down,” she said. “That was really a huge indicator that this process is working.”
The session will outline key changes the UK HealthCare ED made to streamline the handoff process and improve efficiencies. It will talk about how its nurse handoffs were previously structured before making these changes, which pain points it identified that slowed things down, and three specific changes the ED made to the process.
For instance, one of those changes involved simply “flipping” when the nurse handoff process began. Instead of waiting to start the handoff process when the inpatient bed was clean and ready — resulting in a clean bed sitting empty — they shaved minutes off transfer time by starting the handoff process while the bed was being cleaned.
“When it was ready, then we could just issue transfer and not have to do the whole act of a nursing handoff,” Stacy said.
Stacy said the ED’s process improvements can be translated to other facilities as well. It was not only effective in its adult ED, but it is being implemented in other EDs too, including UK HealthCare’s pediatric and community hospitals.
“Within the realm of UK HealthCare, we were able to translate it to three different populations in three different institutions,” she said.
Stacy hopes attendees come away from the session with easy, nurse-driven strategies to reduce boarding in their own departments.
“Hopefully, they’ll leave with concrete, small, but impactful changes they can implement,” she said. “With these three changes, we made a huge impact. But I think even standing alone, one of these changes could definitely impact the throughput of their institutions and their ability to care for more patients.”