Three P's - Productive (In)Patient Procedures: Homework Before Handoff

Project Topic:

Reduce the number of inpatient cases being cancelled, reduce inpatient LOS in endoscopy department, and improve accountability and communication within the endoscopy team.

Hospital, City and State:

Providence Holy Family Hospital, Spokane, WA

Unit:

Endoscopy

CSI Participants:

• Paula Stenson-Atkinson, BSN, RN
• Carin Scott, ADN, RN

Project Goals/Objectives:

1. Improve AACN Healthy Work Environment Assessment Tool (HWEAT) Skilled Communication score from 3.29 to above 4.
2. Improve HWEAT True Collaboration score from 2.98 to above 4.
3. Decrease add-on cancelled cases 50%.
4. Decrease overtime 5%
5. Increase cases 10%
6. Increase use of handoff forms by nursing supervisor and Physician Assistants to 75%

Project Outcomes:

1. Improved the baseline HWEAT Skilled Communication score to 3.61 (baseline 3.29)
2. Improved the baseline HWEAT True Collaboration score to 3.52 (baseline 2.98)
3. Decreased add-on cancelled cases 18%
4. Decreased overtime 19%
5. Increased the number of Endoscopy cases performed by 62.4% (3149 to 5113 cases)*
6. Increased utilization of homework before handoff forms
7. Decreased the amount of overtime in the endoscopy department by 19% (877 hours to 705 hours)
8. Potential annual fiscal impact is $1,401,281

*Multiple other initiatives contributed to increased cases so this wasn’t included in total potential fiscal impact

Project Overview:

Endoscopy nurses recognized inpatient procedures were frequently being cancelled due to preventable causes. These cancellations increased the length of time patients required NPO status, contributed to patient dissatisfaction and stress, increased the time staff were off the unit unnecessarily transporting patients, and limited their ability to keep a productive unit flow with add-on cases. They understood improved collaboration and communication could impact these barriers. The endoscopy nurses revised existing hand-off tools to make them more efficient and catching potential cancelled cases prior to the patients being brought down to the department.

From June 2023 to December 2023 there were 141 total cancelled endoscopy cases. Our CSI team identified decreased inpatient cancellations as one of the focuses of our patient care improvement process. First, the department took the HWEAT survey. We then identified the areas that are impacting our team, True Collaboration and Skilled Communication. Next, we looked at the existing tools to address inpatient add-on cases. We then narrowed down and identified the potential reasons that inpatient cases are cancelled. Next, we revised the inpatient add-on tools to incorporate the areas of concern with the assistance of our anesthesiologists and certified nurse anesthetists. Our approach also encompassed revising the add-on toll that the nursing supervisors utilize after hours and on weekends. As a result of our project, inpatient cancelled procedures decreased 18% and procedures performed increased by 62.4%.

From June 2023 to December 2023 the average Length of Stay (LOS) in the endoscopy department was 3.2 hours. As a result of our project the average Length of Stay in the endoscopy department decreased to 2.15 hours.

The outcomes from our project have been greater than we initially anticipated. We not only reduced the number of cases performed and LOS in the endoscopy department, but we also increased the aggregate scores in True Collaboration and Skilled Communication. Educating staff, nursing supervisors and Physician Assistants on the proper use of the tools has positively impacted patient outcomes and patient satisfaction. In addition, the staff’s participation and accountability in the patient’s care has increased.