Self-evaluation can trim nursing delays
You can speed up clinical turnaround, says expert
More and more, critical care units seem to resemble emergency departments (EDs) in the pace and intensity of acute patient care. In both areas, effective time management has become crucial to achieving positive clinical outcomes.
"Critical care decisions no longer apply only to the ICU," says Linda Kosnik, RN, chief nursing officer of 400-bed Overlook Hospital in Summit, NJ. "Emergency and cardiac care units share in the same time pressures to deliver good, quality care to critically ill patients."
Consequently, CCU nurses can benefit from lessons learned in the best-run EDs, which have trimmed turnaround time in areas such as X-rays. Unnecessary delays in completing these standard patient-care procedures have frustrated busy nurses and led to less than optimal outcomes in clinical care, Kosnik says.
Kosnik advises managers to use a little creativity in shortening the time from initiating orders to the arrival of anything from medications to X-rays. Overlook has been recognized by the Health Care Financing Administration and the American Hospital Association among other authorities for its benchmark innovations in time-to-delivery in nursing care.
Hospital cut X-ray delays in half
The hospital has won awards for patient satisfaction and time-to-thrombolytic performance in emergency cardiac cases.
Nurses and physicians cut the waiting time by more than half on X-ray orders by evaluating the procedure and simply changing the sequence of certain events in the process. In doing so, administrators were careful to avoid violating legal or licensure requirements or to overstep accreditation standards.
Whereas it used to take 75 minutes for X-rays to be ordered, taken, read, and delivered, it now takes less than 30 minutes, Kosnik says. Here’s how she advises hospitals to do this:
• Create a clinical team to explore ways of reducing existing turnaround time.
• Set benchmarks on desired goals and time targets based on realistic expectations.
• Develop a visual flowchart that illustrates the existing process from order to delivery.
• Evaluate how changes in each step of the flow chart will affect time-to-delivery and the effectiveness of the delivery on patients.
• Initiate changes to the process slowly and in monitored phases.
In doing so with X-ray orders, managers found that "lots of extras were built into the system only to accommodate the X-ray department," Kosnik says. Considerable time was spent waiting for the X-ray tech to get around to shooting the film [and] collecting it. Waiting for the radiologist to read the results caused the biggest delay.
The staff agreed to eliminate the wait involved in the reading of the film and placed that step at the end of the process. Now X-rays are rushed to the ED where emergency physicians read the film first to help determine treatment plans. The film is still read by the radiologist, but after the attending physicians gets a first look, Kosnik says.
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