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Admission RN Pilot
Tower 3
Angelica Ahonen RN, MSN, CMSRN
Jaclyn Gallegos Ettenger RN, BS, MSN
University of California Irvine
Medical Center
January 30, 2012
EP8i, Admission RN Pilot Presentation.pdf
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Situation: 3 Tower
Opportunity to improve
patient throughput & safety
• 28 bed telemetry unit
• Fast patient turnover: average LOS 3 days
• High demand for tele beds from ED and house-wide
• ED frequently full and waiting for tele beds
EP8i, Admission RN Pilot Presentation.pdf
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Background: Patient Throughput on 3Tower
– 6.8 admissions from ED/day
• Each admit requires minimum 1 hour RN time
– 6 -7 discharges/day • Average physician discharge orders at 2:45 pm
• Average patient being discharged at 5:00 pm
– 3 transfers in/day
– 3 transfers out/day
– Conclusion: Daily 1/3 patient turnover
EP8i, Admission RN Pilot Presentation.pdf
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Assessment
• ED Impact of waiting for tele beds – Increase in ED patient wait times
– Increased hours of diversion
– Decrease in patient satisfaction
– Decrease in staff morale
• Avg. monthly incremental overtime 82.5 hours
• 3Tower RN staff voice increasing stress – Q3 Gallup 2011:
“At work I have the opportunity to do what I do best every day “
3Tower ranked 3.51, compared to 4.04 for all Med-Surg division
• Preliminary nurse survey results
EP8i, Admission RN Pilot Presentation.pdf
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EP8i, Admission RN Pilot Presentation.pdf
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EP8i, Admission RN Pilot Presentation.pdf
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Staff Survey Created
“I am satisfied with the admission process on 3 Tower”
“Admissions affect the accuracy and/or completeness of my charting”
“Admissions increase my work related stress”
“Frequent admissions decrease my time at the patient’s bedside”
“Frequent admissions cause me to think about transferring to a
different unit”
“Admissions cause fragmentation of my ability to care for my patients”
“Admissions contribute to the likelihood of me working overtime”
“Admissions decrease the level of safety of my nursing practice”
“The admission process helps establish a strong sense of teamwork”
EP8i, Admission RN Pilot Presentation.pdf
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0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
Nu
rse
Ave
rage
Sat
isfa
ctio
n S
core
(0
-9)
Individual Nurse (13 Survey Responses)
Nurse Average Satisfaction of Admission Process on Tower 3
EP8i, Admission RN Pilot Presentation.pdf
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33.3
66.7
0.0 0.0 0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Never Occasionally Often Always
Pe
rce
nta
ge o
f N
urs
es
Nurse Response
"I am satisfied with the admission process on Tower 3"
EP8i, Admission RN Pilot Presentation.pdf
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7.7
23.1 23.1
46.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Never Occasionally Often Always
Pe
rce
nta
ge o
f N
urs
es
Nurse Response
"Frequent admissions cause me to think about transferring to a different unit"
EP8i, Admission RN Pilot Presentation.pdf
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15.4
7.7
30.8
46.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Never Occasionally Often Always
Pe
rce
nta
ge o
f N
urs
es
Nurse Response
"Admissions contribute to the likelihood of me working overtime"
EP8i, Admission RN Pilot Presentation.pdf
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23.1
7.7
38.5
30.8
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Never Occasionally Often Always
Pe
rce
nta
ge o
f N
urs
es
Nurse Response
"Admissions decrease the level of safety of my nursing practice"
EP8i, Admission RN Pilot Presentation.pdf
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Recommendation
• Pilot an Admission RN on 3 Tower
• Schedule: Mon., Tue., and Fri. 2 pm – 2:30 am to match busiest ADT times
• Pilot will span from January 23rd, 2012 to opening of Tower 5 tele unit: ~ 3 months
EP8i, Admission RN Pilot Presentation.pdf
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Admission RN Job Description • Admission
• Receive report from ED RN
• Prepare room for patient
• Greet patient and family to unit
• Patient setup: tele box, IV, etc.
• Complete Nursing Admission Assessment
• Supplemental Teaching & Suicide Risk Screening
• Medication reconciliation
• Report to primary RN
• Transfer & Discharge • When not admitting patients, all remaining time is
devoted to activities to facilitate transfers & discharge
EP8i, Admission RN Pilot Presentation.pdf
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Measures of Success
• Throughput: request for bed to patient admission on unit
• RN Overtime: Compare incremental OT rate before and after
• RN satisfaction: survey before and after
• Patient Satisfaction: Nursing communication with patients via AVATAR survey results Current benchmark is 67.77
• Admission data completeness: chart audit before and after
EP8i, Admission RN Pilot Presentation.pdf
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Discover Teach Heal
• Discover:
– Improve admission process through piloting EBP
• Teach:
– Improve patient teaching and be the trail blazer for other units
• Heal:
– Improve patient outcomes
EP8i, Admission RN Pilot Presentation.pdf
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References Giangiulio, M., Aurilio, L., Baker, P., Brienza, B., Moss, E., & Twinem, N. (2008). Initiation and evaluation of an
admission, discharge, transfer (ADT) nursing program in a pediatric setting. Issues in Comprehensive Pediatric Nursing, 31, 61-70.
Hlipala, S. L., Meyer, K. A., Wallance, T. O., & Zaremba, J. A. (2005). Profile of an admission nurse. Nursing Management, 36(6), 44-47.
Lane, B. S., Jackson, J., Odom, S. E., Cannella, K. A. S., & Hinshaw, L. (2009.). Nurse satisfaction and creation of an admission, discharge, and teaching nurse position. Journal of Nursing Care Quality, 24(2), 148-152.
Morgan, R. (2007) Turning around the turn-arounds: improving ED throughput processes. Journal of Emergency Nursing, (33)6, 530-536.
Spiva, L. & Johnson, D. (2012). Improving nursing satisfaction and quality through the creation of admission and discharge nurse team. Journal of Nursing Care Quality, 27(1), 89-93.
Siehoff, A., Gancarz, B., & Wise, C. (2009) Improving patient admissions with dedicated admission nurses. Journal of Nursing Administration, 39(1), 11-13.
EP8i, Admission RN Pilot Presentation.pdf
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