An evidence-based practice approach to increase admission bed availability on medical-surgical units.

摘要

Emergency Department (ED) crowding and ambulance diversion is now a commonplace occurrence in hospitals across the United States, a direct end result of the imbalance between admission bed need and available beds to meet admission the bed demand. The purpose of this evidence-based practice project was to evaluate the impact of the unit based APN facilitated discharge from the medical-surgical units on the median wait time for adult ED patients to be admitted to a vacated bed compared to patient discharge by physician. The APN facilitated discharge incorporated bed management to prioritize and streamline timely patient discharge on two medical-surgical units, a 19-bed urology/transplant unit with 1,200 admissions per year (Unit A) and a 15 bed general medical-surgical unit with 4,000 admissions per year (Unit B). A pre-intervention chart review data on physician initiated discharge was compared with the post-intervention mean time from ETD admission order to bed occupancy. Results: The mean wait time from ETD admission order to a vacated bed in the standard physician discharge for Unit A was 8.81 hours and for Unit B was 7.29 hours. In the APN facilitated discharge, the mean wait time from ETD admission order to a vacated bed was 4.76 and 5.66 hours for Units A and B respectively with a p = < 0.05 of significance in the difference between the mean for both units. Conclusion: The Wilcoxon Signed Rank Test showed no reduction in the median wait time with APN facilitated discharge in each unit, but showed significance at p=0.05 when both units are compared.;Keywords: ED overcrowding, in-patient bed admission, patient discharge, advanced practice nurse, patient flow, throughput, bed occupancy, emergency department wait time, medical- surgical.