Make It Your Hobby, To Check on the Lobby

Project Topic:

Increase clinician wellbeing in the Emergency Department lobby, by increasing patient safety with standardized monitoring of patients and decreasing left without being seen (LWBS) patients

Hospital, City and State:

Providence Sacred Heart Medical Center, Spokane, WA

Unit:

Adult Emergency Department

CSI Participants:

• Kenda Bishop
• Berlyn Davis
• Daveena Maple

Project Goals/Objectives:

1. Increase AACN Healthy Work Environment Tool (HWEAT) score for Appropriate Staffing from 2.76 to above 3
2. Increase HWEAT score for True Collaboration from 2.62 to above 3
3. Decrease LWBS patients from 7.8% to 4%
4. No adverse events in the ED lobby
5. Increase clinician well-being, patient satisfaction and safety in the ED lobby
6. Ensure appropriate staff is placed in the ED lobby
7. Decrease lost revenue due to left without being seen (LWBS) patients

Project Outcomes:

1. Increased HWEAT Appropriate Staffing score to 3.42
2. Increased HWEAT True Collaboration to 3.09
3. Increased LWBS to 8.5% (last 3 months decreased to 6.4%)
4. No adverse events in the ED lobby

Project Overview:

The lobby is the most dangerous place for patients and staff in the ED. Patients are unmonitored and often not checked on for several hours. Many nurses will refuse to work out in the lobby due to the stress. Many sentinel events occur because patients are forgotten.

The CSI team started gathering information by sending out a staff survey to find out what staff thought was the most unsafe thing in the lobby and to get suggestions about how to fix the problem. It was found that the staff did not like the unknown. In the department, critically ill patients are hooked up to monitors, but in the lobby that is not possible. We decided to focus on a standardized schedule for “revital-ing” patients in the lobby. Research showed that checking vitals on patients every two hours would show patients that you did not forget them, thus decreasing patient agitation and the LWBS numbers.

Our project was launched with us educating staff during all employee huddles with a focus on the staff working on a team to revitalize patients. We created an expectation card with answers to commonly asked questions, educated staff, and posted for patients. The goal is to take pressure off staff so patients/families have opportunity to share concerns as staff does a quick check-in assessment on patients. We didn’t increase staffing, but had structure/process in our lobby, and this helped staff in the lobby work as a team. Champions of our project were chosen to champion the project and help it be successful. To encourage staff participation staff drawings and parties were thrown to make sure staff understand how important it is to vital patients. Redosing included a “champion board”, titled “triage a team sport: No one wants to feel forgotten”. We had a title on this of reassessment and vitals save lives, promotes safety and improves satisfaction. Staff shared stories of successes.

Our LWBS percentage increased to 8.5% during our project with many reasons for this. Our purple zone was closed (June-October) for much of the project timeframe and was one reason for increasing this percentage. Of note when this additional zone was reopened (October-December) the LWBS decreased to 6.4%. Our sustainability plan includes incorporating lobby training in new hire orientation, encouraging staff to use the QR code connected with our expectation card (as another way to access it), implement a triage orientation for all employees, and having our Unit Based council review LWBS quarterly sharing results.

Although we experienced many challenges and much pushback from staff, at least 81% of staff felt that working in the lobby was slightly better by the end of the project. All HWEAT standards increased, correlating with improved environment.