It’s Crunch Time

Methodist Children’s Hospital (San Antonio, Texas)

CSI Summary

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CSI Presentation

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CSI Toolkit

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Added to Collection

Project Topic

Change-of-shift admissions

Hospital Units

Pediatric Surgical Unit (PSURG), Pediatric Intermediate Care Unit (PIMC) and Pediatric Medical Unit (PMED)

CSI Participants

Meg Brown BSN, RN
Adri Davenport, MSA, RN, CPN
Vanessa Deleon, BSN, RN, CPN

Project Goals/Objectives

  1. To increase nurses’ perception of patient safety at shift change
  2. To decrease overtime by 10 percent
  3. To maintain patient perception of quality (PPQ) survey results above the 75th percentile

Project Outcomes

  1. Decreased overtime 57 percent on PSURG and 21 percent on PIMC
  2. These outcomes resulted in an estimated annual fiscal impact of $93,380.

Project Overview

Change-of-shift admissions are problematic for many inpatient hospital units. The goal of our project was to address this concern from a nursing standpoint in the PSURG, PIMC and PMED units.

We began bringing in our charge nurses for their shifts 45 minutes earlier in order to receive report in a time-efficient manner. This would make the charge nurses available to receive change-of-shift admissions and get the patients settled for the floor nurses.

Through surveys during this project, we discovered that our nurses’ perception of shift-change admissions improved, mostly due to staff nurses no longer having to handle change-of-shift admits. We saw a significant decrease in overtime during our project, though we recognize many factors contribute to overtime.

Our Crunch Time protocol has become a standard expectation among these three units. We have also expanded our project to the non-specialty areas of the children’s hospital that receive the most admissions. To help sustain the project going forward, we aim to standardize handoff report and implement the project in the charge nurse academy.

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The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.