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1 NURSING Excellence MAY 2013 CONGRATULATIONS TO OUR Nurse of the Year Winners Amanda M. Flaherty BSN, RN, RNC-NIC Nurse of the Year Clinical Practice C. Leanne Kozub BHCA, RN, CLNC Nurse of the Year Education Jocelyn Alsdorf MSN, RN, CPON Nurse of the Year Advanced Practice LuAnn Joy BSN, RN, MBA, NE-BC Nurse of the Year Administration/Leadership

2 May 2013 TABLE OF CONTENTS To navigate through the newsletter, click on any title. The Drivers of our Practice 3 By Beverly Hayden-Pugh, MOB, BSN, RN Vice President and Chief Nursing Officer Applying the Nursing Professional Practice 4 Model at the Bedside - Nursing Professional Practice Model: What it is to me Megyn Hildebrandt, BSN, RN - My Professional Practice Wendy Danell, RN Governance 6 - Nursing Governance 2013 Accomplishments Denise Vermeltfoort, MSN, RN, NE-BC Professional Practice 7 - Professional Organization Denise DeFendis, BSN, RN, CAPA - Nursing Leadership in Professional Organizations Collaborative Relationships 10 - Collaborative Relationships: Service & Academia Patricia Lindsey, MSN, RN, CNS, CPN Outcomes 11 - Outcomes: Emergency Department Patient/Family Satisfaction James Brusenback, BSN, RN Professional Development 15 - Heart Code Mary-Ann Robson, BSN, RN, CCRN - National Certifications at Children s - Academic Advancement Life Happens and Plans Change LuAnn Joy, BSN, RN, MBA, NE-BC Continuing Education in the Field of Nursing Today Lisa Radesi, MSN, RN, CNS, CEN, CPEN My Professional Development Journey: On the Road to the BSN Wendy Hess, RN Reward and Recognition 20 - Nurse of the Year Awards Administration/Leadership LuAnn Joy, BSN, RN, MBA, NE-BC Advanced Practice Jocelyn Alsdorf, MSN, RN, CPON, PNP-BC Education Christine (Leanne) Kozub, BHCA, RN, CLNC Clinical Practice Amanda Flaherty, BSN, RN, RNC-NIC - Friend of Nursing Award Madeline (Maddie) Soto Theoretical Framework 23 - Theory: Questions and Answers Objectives of this Continuing Education Program Mary (Betsy) Muller, PhD, RN, WHNP-BC Research/Evidence-Based Practice 13 - Research - Publications - Presentations

3 Beverly Hayden-Pugh, MOB, BSN, RN Vice President and Chief Nursing Officer Happy Nurses Week! Each day is a day to celebrate our profession, but Nurses Week provides us with the opportunity to reflect and commemorate. Our practice is driven by many things but perhaps one of the most important is our values. As I visit with nurses, providers, patients and families, I see and hear of the impact of our core values: excellence, compassionate care, innovation, integrity, collaboration and stewardship.¹ In this special edition of the Nursing Excellence Newsletter, we celebrate the profession of nursing. Stories of how the Children s Hospital Nursing Professional Practice Model is applied are presented by nurses throughout the organization. Accomplishments of our Nursing Governance Structure, individual accomplishments of academic advancement and national certification and contributions through research, publication and presentation are shared. Join us as we acknowledge the achievements of our Nurse of the Year Clinical Practice, Amanda M. Flaherty, BSN, RN, RNC-NIC; Nurse of the Year Education, C. Leanne Kozub, BHCA, RN, CLNC; Nurse of the Year Administration / Leadership, LuAnn Joy, BSN, RN, MBA, NE-BC; and Nurse of the Year Advanced Practice, Jocelyn Alsdorf, MSN, RN, CPON. These nurses are role models of our core values. Thank you for the compassionate, innovative and quality care you provide; your collaboration in governing our profession; and commitment to excellence. Through your efforts we continue to meet the needs of the children and families we serve. I am honored to serve with you. Reference ¹ Mission and Vision, Children s Hospital Central California, October 2011.

4 Applying the Nursing Professional Practice Model at the Bedside The Nursing Professional Practice Model is a dynamic framework that encompasses attributes, systems, structures and processes that support the clinical practice of nurses and promote a professional practice environment. The model reflects, drives and supports nursing practice at the bedside. Megyn Hildebrandt, RN, and Wendy Danell, RN, share their stories of how the Nursing Professional Practice Model supports the care they provide to their patients. Reference 1 Adapted from Vermeltfoort, D., Dragomanovich, M, and Mountcastle, K. Common Components of Current Nursing Professional Practice Models in the Hospital Setting in the United States of America A Qualitative Study. Nursing Professional Practice Model: What it is to me By Megyn Hildebrandt, BSN, RN A nursing professional practice model is important because it provides the terminology that enables me to articulate what it is that I do as a bedside nurse and why. The best part about the Nursing Professional Practice Model is that it s so deeply rooted in who we are as nurses that we may not even be aware that everything we do on a daily basis fits somewhere into the model. In the NICU we start our day with a huddle in the lounge. This exemplifies the Communication component, as does the format in which we perform patient hand-off at shift change. From there we use the Operations piece through our Advanced Clinical Systems (ACS) documentation to research further background on our patients, know more about what is to happen on that specific shift, and prepare for the next step in their healing journey. Then we begin our hands-on assessments, medication administration, feedings, various tests, etc all of which are supported by Research and Evidence-based Practice as illustrated by our policies and procedures. Collaborative Relationships occurs throughout the day with multiple specialties including but not limited to: respiratory care, physical therapy/occupational therapy (PT/OT), speech-language pathology, physicians, laboratory, radiology, health unit coordinators and patient care technicians. This ensures every patient is supported by a dynamic system comprised of a multifaceted, interdisciplinary team. Each day we strive to learn something new, which coincides with Patricia Benner s Novice to Expert theory for the Theoretical Framework portion of the model. Through my process of starting out as a pediatric nurse extern and moving through nursing school, orientation classes, core classes, the Neonatal Resuscitation Program and unit-based training, I demonstrate our Professional Development component while continuing on my way to becoming an expert NICU nurse. The Care Delivery that I perform each day I come into work is intimately founded in our Professional Values as seen by our mission, vision and core values statements. Nursing is a highly complex, challenging and rewarding field, and a professional practice model provides us with the language to relay that to others. It describes what we do and why, gives us a roadmap for our practice and provides insight and clarity to the profession by utilizing phrases and descriptors to illustrate this amazing career. My Professional Practice By Wendy Danell, RN Practicing to the Children s Hospital Nursing Professional Practice Model (NPPM) is something we do as nurses everyday without thinking twice. While it does not define who we are, it defines what we do and how well we do it. The NPPM encompassed the care I delivered to a patient who had experienced a relapse of cancer while I was working as a licensed vocational nurse (LVN). A diagnosis of cancer in a child affects the whole family, creating great uncertainty in daily life. Nurses, as part of a multidisciplinary team, can help families adjust by providing emotional and practical support. ¹ Continued next page

5 My story highlights several components of our NPPM. I walked into the patient s room to meet my patient and his mother after I received report from the previous shift. I had already begun Collaborative Relationships with my team members from physical and occupational therapy. Once our plan was in place I introduced it to my patient and family, who had been hit hard by a relapse in his illness. The Communication process began immediately as I discussed with both the patient and his mother the plan for Care Delivery by the healthcare team. The patient was less than excited about the plan but I assured him that we wanted to assist him in the regaining of his strength and independence. This was a time of great Professional Development for me as a LVN. Collaboration occurred daily between the registered nurse and me to provide the best care possible for the patient. During this time, I was attending college and working toward the completion of my registered nursing degree. The opportunity to care for this patient and family was very meaningful to my professional development. I did not become a registered nurse for the monetary advantages or benefits that accompany the title; I became a registered nurse for the pure joy and satisfaction of helping others. My Reward and Recognition comes in the eyes of my patients and their families, much like it did with this cancer patient and his family. I am not sure if this remarkable patient or family have any idea how much they impacted my life, but they did, and for that I will always be grateful. Experiences like these have enriched my nursing practice. The twelve components of the Children s Hospital NPPM help me as a registered nurse to define my actions and explain what I do in my daily practice that exemplifies the continuous links of the model. Each of the components in the model holds significance and is equally important in my practice. When I received the designation of registered nurse, I assumed the role of professional nurse and I am happy the Children s Hospital NPPM helps me define the practice I love. Reference ¹ Tedford, J. & Price, J., (2011). Role of the nurse in family-centered care. Cancer Nursing Practice, 10(2), pp Retrieved from: archive/article-role-of-the-nurse-in-family-centred-care

6 Governance Denise Vermeltfoort, MSN, RN, NE-BC Director Regulatory and Clinical Practice The Nursing Professional Practice Model at Children s Hospital Central California defines governance as organizational structure for the oversight of nursing practice. Children s Hospital s governance structure includes nursing councils and interdisciplinary committees that provide oversight for practice and family-centered care. Leadership is provided by the Executive Nursing Council, which is comprised of nursing directors, managers, charge nurses, council chairs and direct care staff nurses. Reporting to the Executive Nursing Council are the: o Practice Council o Nurse Practitioner Council o Nursing Peer Review Committee and Restraint Subcommittee o Nursing Research Council o Patient Care Division Leadership o Nursing Informatics Council o Professional Development Council Interdisciplinary committees include the Customer Service Committee and Family-Centered Care Steering Committee, Lactation Committee, Palliative Care Steering Committee, Patient/Family Education Committee and Cultural and Linguistic Subcommittee in Action. In fiscal year 2012, the councils and committees provided leadership and/or contributed to a number of quality, patient safety and professional practice initiatives supporting the Nursing Professional Practice Model. A representation of their efforts is summarized below. Professional Development The Research Council developed two learning modules to support staff in the research process. Continuing education units were offered and the modules are available on icare. The Nurse Practitioner Council supported the implementation of Computerized Provider Order Entry through five nurse practitioners (NPs) serving as coaches for providers and staff. The Professional Development Council provided education on new products including Versa Care Beds, Dual Oral Thermometer, Covidien Kangaroo Pump 924, Zoll R-Series defibrillator, Pain Management for Venous Access and Sigma Pump upgrade. Clinical Orientation was restructured to support new programs, processes and technology. A web-based traveler orientation was developed. Patient safety was supported through education related to prevention of pressure ulcers and nosocomial infections. Heart Code Basic Life Support (BLS) was initiated as the new standard for BLS training. Care delivery was supported through education on restraints, ethanol lock therapy, pediatric early warning score, lactation and documentation. Communication The Practice Council initiated a new process to facilitate communication of new practice and products issues across the continuum. They also collaborated with Nursing Informatics Council and Professional Development Council to enhance communication between the councils to ensure coordination of changes in practice, documentation and education. Professional Practice The Nurse Practitioner Council modified the Scope of Practice/Delineation Form to enhance proctoring requirements and integration of new standardized procedures. The Nursing Peer Review Committee reviewed cases for the identification of opportunities for improvement in patient care. The Restraint Committee initiated a 100 percent review of restraints to ensure compliance with policy and associated documentation. Reward and Recognition Nursing practice and individual nurses were recognized throughout the year. The Nurse Practitioner Council recognized Nurse Practitioner Week. The Executive Nursing Council selected the Nurse of the Year recipients. The organization celebrated Nurses National Certification Day in March. Events during Nurses Week included: A clinical leadership workshop with keynote speaker Holly Green speaking on Thinking Differently to Thrive in Today s Hyper-Paced World, Nurse of the Year awards ceremony, RN Education Fair, Nursing Scholarship Annual Basket Fundraiser, Special edition of the Nursing Excellence Newsletter, Excellence in Nursing Poster Session and Journal Club. A total of $12,901 was raised for Nursing Scholarships. Continued next page

7 Continued from previous page Collaborative Relationships The Nursing Peer Review Council co-chairs provided education on the Peer Review process to a local hospital supporting the sharing of best practices in the community. The Palliative Care Committee collaborated with hospice organizations in the region to ensure knowledge of pediatric hospitals and palliative care and participate in networking opportunities. Care Delivery The Nursing Informatics Council continued with enhancements to Advanced Clinical Systems (ACS), supporting the documentation of nursing care. The Visual Flow sheet was enhanced and pathways/order sets for nursing were improved. Nursing documentation was streamlined. The efforts supported by the members of the Nursing Governance Councils/Committees are reflective of the core values of Children s Hospital: excellence, compassionate care, integrity, innovation collaboration and stewardship. Their ongoing commitment ensures quality care is provided within a professional practice environment. Reference 1 Adapted from Vermeltfoort, D., Dragomanovich, M, and Mountcastle, K. Common Components of Current Nursing Professional Practice Models in the Hospital Setting in the United States of America A Qualitative Study. Professional Practice Children s Hospital Central California defines Professional Practice as the structure, standards and regulations which govern the practice of nursing. This includes the Nurse Practice Act, professional standards of practice, nursing bill of rights, engagement in professional organizations, legislative advocacy, engagement in the profession and advanced practice credentialing and privileging. Membership in professional nursing organizations abounds and includes nurses serving in leadership positions. Denise DeFendis is one such nurse who is serving as the District Director for PeriAnesthesia Nurses Association of California (PANAC). Reference 1 Adapted from Vermeltfoort, D., Dragomanovich, M, and Mountcastle, K. Common Components of Current Nursing Professional Practice Models in the Hospital Setting in the United States of America A Qualitative Study. Professional Organization By Denise DeFendis, BSN, RN, CAPA Education Coordinator, Day Surgery The term being a professional was described to me in a profound way, not in a nursing class, but in a microbiology class. The instructor explained, Having a job is one thing but to be a true professional requires more. It requires staying on top of current information by attending seminars, being involved in professional organizations and reading current practice journals. This conversation was many years ago but holds true today. Professional organizations exist to promote the quality of service provided. Membership in a professional organization has many options. You can choose the level of involvement that works best for you. I first became a member of a nursing organization when I was working in the emergency department. The organization was Emergency Nurses Association (ENA). I paid my dues and took the required classes. Professional involvement was minimal at this stage of my life due to being busy with family. I felt nothing but admiration for nurses who were so much more involved in ENA. Their example and enthusiasm were definitely something to strive for. Continued next page

8 Continued from previous page After transferring to the post anesthesia care unit (PACU), two professional organizations were constantly being referred to: Association of Operating Room Nurses (AORN) and American Society of PeriAnesthesia Nurses (ASPAN). Both of these organizations have standards that guide our policies and the care we provide to our patients in the peri-operative department. In other words, these professional organizations are experts in our field of practice. AORN provides membership to nurses who work in any area of the peri-operative world but their main focus is the operating room (OR). The main focus of ASPAN is to define and establish the nursing scope of practice to the following areas, though not limited to: preadmission, day of surgery/procedure and post-operative level of care for Phase I, Phase II, and Extended Care. PeriAnesthesia Nurses Association of California (PANAC) is at the state level of representation. There is also a local Fresno area chapter. During my time in PACU, I joined ASPAN and PANAC at the encouragement of staff. I had retained this membership when I transferred to the day surgery department a few years later and became more involved. I started attending seminars. The fellowship of meeting other nurses who worked in the field was rewarding. The networking provided a chance to share ideas, concerns and educational opportunities. Seminars provide so much information and education. By attending these seminars and sharing this information, changes have been brought about that have improved the quality of care provided to perianesthesia patients. ASPAN offers national certification through the American Board of Perianesthesia Nursing Certification (ABPANC). Two types of national certification are offered: Certified PeriAnesthesia Nurses (CPAN) for nurses who work in PACU and Certified Ambulatory PeriAnesthesia (CAPA) for nurses who work in the pre-op area and in the post-op area of day surgery. Ten years ago, I made the decision to obtain my national certification. A group of nurses from the various facilities in the Fresno area gathered together and studied on a weekly basis. We learned a lot. The thrill of obtaining a national certification is unbelievable! Children s Hospital is very supportive of nurses obtaining their national certification. In fact, testing fees are reimbursed upon passing. National certification was recognized and encouraged by Children s Hospital even before Magnet Recognition was obtained. Gathering to study for the national certification exam helped launch our local chapter for the Fresno area. We continued to meet even after the testing and now we meet almost monthly. I have grown leaps and bounds from when I first became a member of a professional organization, and am now the Director of District 5 for PANAC. My district covers the counties of Fresno, Inyo, Madera, Mariposa, Mono, Kern, Kings and Tulare. I have learned so much in this role. My next goal is to become a certification coach so that I may encourage and help others in the perioperative field earn their national certification. As much as I have put into being a member of a professional organization, I have gotten back so much more. Even if you are not at a stage in your life when you can do it all, start out by joining and grow from there. Reference American Society of PeriAnesthesia Nurses, Scope of Perianesthesia Nursing Practice in the Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements. Cherry Hill, NJ:ASPAN; 2012:6,10. Nurse Leadership in Professional Organizations Many Children s Hospital nurses collaborate through participation in professional nursing organizations. Their leadership has enhanced the knowledge and skill of nurses. They have shared best practices and advocated, ultimately impacting patient care and the profession. The nurses listed below serve as leaders in local, state and national organizations: American Association of Critical Care Nurses: (AACN) San Joaquin Chapter Ambassador: Oliver ( Lee ) Pelayo, BSN, RN, CCRN Ambassador: Rachel Caro, BSN, RN, CCRN American Society of PeriAnesthesia Nurses (ASPAN) Chair, Government Affairs: Beverly Edwardsen, BS, RN, CPN Association of California Nurse Leaders (ACNL) Project Team Member: LuAnn Joy, BSN, RN, MBA, NE-BC Association of Operating Room Nurses (AORN) Central San Joaquin Chapter President and Parliamentarian: Terri Heitzman, RN, CNOR Vice President: Kristine Scaffidi, BSN, RN, CNOR California School Nurses Organization Chair Governmental Relations Committee: Maureen F. Doyle, MSN, RN, Credentialed School Nurse Continued next page

9 Continued from previous page California State University, Fresno, Nursing Alumni Association Vice President: Brandi Guthauser, MSN, RN Central San Joaquin Valley Nursing Leadership Coalition (CSJV-NLC) Board Member/Treasurer: Daniel Davis, MHA, BSN, RN, NE-BC Central California Association of Neonatal Nurses (CCANN) President: Kamela Loo, MSN, RNC-NIC, CFNP, CNNP Secretary: Adam Hensley, RN Board Member, Officer: Rowena Maagma, RN, RNC-NIC Board Member, Education Officer: Linda Sepulveda, RNC-NIC, RNFA Treasurer: Roces Velasco, BSN, RNC-NIC Educators of Central California Health Care Organizations (ECCHO) an affiliate of National Nursing Staff Development Organization (NNSD) Board Director: Jean Hoelscher, MSN, RN, BC Emergency Nurse Association (ENA California) Co-Director at Large and Secretary: Serena Danbry, RN Emergency Nurse Association (ENA Mid Valley) Chapter President: Janet Williams, ASN, RN Treasurer: Rupinder Eggleston, ASN, RN, CPEN Secretary: Serena L. Dansby, BSN, RN PeriAnesthesia Nurses Association of California (PANAC) Board Member and District 5 Director; Contributing Editor of Pulseline: Denise Defendis, BSN, RN, CAPA Board Member and Chair Government Affairs: Beverly Edwardsen, BS, RN, CPN PeriAnesthesia Nurses Association of California District 5 Fresno Chapter Coordinator-Elect and Past Area Coordinator: Frances Buchnoff, RN Historian: Nancy Montano, RN, CAPA Philippine Nurses Association California Chapter (PNACC) Board Member: Mila Nino, BSN, RN Board Member: Glenda Robles, BSN, RN Sigma Theta Tau International, Mu Nu Chapter (STTI) Leadership Succession: Carol Ann Richina, MSN, FNP-C, PMHNP Sigma Theta Tau International, Rho Tau Chapter (STTI) Secretary: Deborah Garner, BSN, RN, IBCLC Society of Pediatric Nurses (SPN) President: Kathleen Remner, BSN, RN-BC, CPN Secretary: Dana Ferris, ASN, RN National Association Hispanic Nurses San Joaquin Valley chapter (NAHN) President: Mary Solis, MA, BSN, RN National Association of Pediatric Nurse Practitioners (NAPNAP) San Joaquin Valley Chapter Membership & Education Chair: Tracy Chin, MSN, RN, CPNP Awards Development Chair: Terea Giannetta, DNP, RN, CPNP Board Member and Communications Chair: Sharon Vander Plaats, MN, RN, PNP, CPNP-AC, CRRN/ CRRN-A - Board Member/Officer: Katherine Baker, MSN, RN, CFNP Treasurer: Michele Grazulis, MSN, RN, CPNP

10 Collaborative Relationships Children s Hospital defines collaborative relationships as partnerships between nursing and the patient/family, peers, the organization, academia and the community. Partnerships occur daily in a number of ways: the planning for care, meeting of committees and councils, designing of systems and processes, and addressing of community needs through inter-agency collaboration. Children s Hospital partners with many schools of nursing throughout the region, providing a quality clinical experience for students pursuing a nursing career. Reference 1 Adapted from Vermeltfoort, D., Dragomanovich, M, and Mountcastle, K. Common Components of Current Nursing Professional Practice Models in the Hospital Setting in the United States of America A Qualitative Study. Collaborative Relationships: Service and Academia By Patricia Lindsey, MSN, RN, CNS, CPN Collaboration enables individuals to partner to achieve a common goal. Collaborative relationships are rewarding when these goals are achieved. They require effort, innovation and partnerships. I suppose that s where the word collaborate originates. Late Latin collaboratus, past participle of collaborare to labor together, from latin com- + laborare to labor. Many groups partner with others to achieve lofty goals they could never accomplish on their own. In our Nursing Professional Practice Model, collaborative partnership examples exist between nursing and the patient/family, peers, disciplines, departments and agencies. Such is the case between Children s Hospital and academia. Hospitals cannot alone create nurses. Likewise, nursing schools cannot create nurses without providing them a clinical environment in which to practice. Naturally, schools and hospitals work together to create new nurses to meet future needs. What happens when several schools compete to have a relationship with a single health institution? Or when healthcare institutions compete to obtain nurse graduates? Competition involves some parties winning and some losing. The solution appears to be clear: promote collaboration while eliminating competition, which requires even more collaboration. This is the origin of the San Joaquin Valley Nursing Education Consortium (SJVNEC). In 2008, local healthcare facilities and nursing schools collaborated to create the SJVNEC with the express goal of coordinating the clinical placement process in order to maximize the availability of clinical sites while mutually benefiting both nursing service providers (agencies) and nursing programs. To assist in the coordinating, SJVNEC initiated a computerized clinical placement system (CCPS), modeled after a similar one in San Diego. The system allowed for all schools to place requests for particular facilities and identify if the date and time conflicted with another school s request within the consortium. The schools collaborate to resolve conflicts. In turn, the agencies can accept, revise or reject the request based on availability. The consortium is a great example of inter-agency collaboration. Currently the consortium involves 17 healthcare facilities and 19 academic institutions. Not all schools attend all healthcare facilities, but this technology has certainly improved the accessibility, efficacy and efficiency of coordinating clinical placements. In 2012, Children s Hospital collaborated with a total of 13 nursing schools to place 60 pediatric student nursing rotations and 53 nursing preceptorships for a total of 920 nursing students. The consortium has begun to enter other allied health student requests into CCPS (e.g., respiratory care practitioners, imaging etc.), expanding its use even further. The consortium collaborates to standardize immunization forms, orientation guides, and drug testing and background check processes. The result of this partnership streamlines the on-boarding process for students for both facilities and academia, thus helping us achieve something we could not achieve alone. Reference 1 Merriam-Webster, Collaborate. Retrieved from dictionary

11 Outcomes Children s Hospital defines outcomes as the achievement of measurable organizational, patient, workforce and community outcomes through quality, safety and performance improvement processes. Multiple outcomes are utilized at Children s Hospital to measure our success in reaching our vision of becoming the nation s best children s hospital. With the patient and family at the heart of everything we do, one of the most important outcomes is their level of satisfaction with the services and care provided. Reference 1 Adapted from Vermeltfoort, D., Dragomanovich, M, and Mountcastle, K. Common Components of Current Nursing Professional Practice Models in the Hospital Setting in the United States of America A Qualitative Study. Outcomes: Emergency Department Patient/Family Satisfaction By James Brusenback, BSN, RN Multiple factors determine how satisfied a patient or family is with an emergency department visit. Care provided, professionalism and friendliness of the physicians and staff, cleanliness of the department, and communication and mutual decision making with the family are just a few of these factors. As we discovered through the implementation of new patient flow processes in our department, there is also an incredibly positive influence on satisfaction through prioritization and expedition of patient rooming and treatment. Children s Hospital Emergency Department undertook an endeavor in the spring of 2011 to change the way patients are roomed and processed. A consultant group was engaged to help us generate data and provide a methodology to implement patient flow change. Via patient flow simulation models, multiple brainstorming sessions and openness by all involved to consider new ways of doing business, several process change considerations evolved and were eventually implemented. For example, prior to June 7, 2011, we required all patients to flow through a triage nurse for an assessment, something we had done for decades. However, this process created a bottleneck to patient flow, and subsequently created long delays in door-to-doctor times. Funneling all patients in this way was fundamentally challenged during our brainstorming sessions. As an alternative, we proposed and then implemented the role of a patient flow coordinator (PFC) whose primary goal is immediate rooming of patients from the triage area after rapid acuity setting. A nursing assessment is not required prior to rooming. The PFC provides for rapid identification and streaming of all patients, whether they come by ambulance or through the front door. The PFC assumes total accountability for rooming patients to open beds, and bases all decisions on patient flow demands. In essence, the PFC is accountable for constant tracking of patient priorities and maintenance of patient flow. Our current process now includes quick registration immediately upon patient arrival. Patients are then routed directly to the triage area where the PFC assigns an acuity level and moves the patient/family to an open bed. The physician or primary registered nurse (RN) is then accountable to assess the patient in the room and complete appropriate documentation. This process has allowed us to utilize all beds in the department for nursing assessment, and has eliminated a significant bottleneck. This improved flow means that patients are seen more quickly, which has been warmly welcomed and recognized by families with comments such as: The staff is very considerate. They took us back right away and ensured that my son was taken care of. Thank you very much. This is the reason why I only bring my children here. The best hospital experience I have ever had. I can t stop telling people about the great experience considering we were in an emergency situation. Additionally, a Team Triage area was created and staffed with nurses, registration, techs and a physician solely dedicated to performing rapid medical screening of all patients who flow through this area. High acuity patients are not processed through Team Triage, so the flow remains steady. The PFC Continued next page

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