Reinhardt Mark R
Corpus Christi, TX.
J Emerg Nurs. 2017 Jul;43(4):329-332. doi: 10.1016/j.jen.2017.01.003. Epub 2017 Mar 30.
• Nurses are uniquely situated to critically evaluate quality and performance measures, identify opportunities for improvement, and recommend potential corrective inverventions within the emergency department. • Nurses can actively contribute to performance improvements that increase quality of care, improve patient outcomes and satisfaction, and reduce institutional liability and risk. • Establishment of a systematic process to identify deficiencies, evaluate problems, and develop solutions is vital to continuous quality improvement.
Increasing ED crowding has resulted in greater demand and longer time-to-triage and time-to-provider wait times, making accurate triage more important than ever before to avoid poor patient outcomes and possible hospital liability. In one case, a 75-year-old patient presenting with chest pain became unconscious in the ED waiting area after initial registration but before triage. Although resuscitation was attempted, the patient did not survive. Continuous assessment and improvement are needed to streamline the triage process and improve accuracy and efficiency. Because nurses play a vital role in patient triage, they are uniquely positioned to evaluate and enhance the process.
When staff at an 18-bed emergency department in a rural hospital suspected potential quality deficiencies related to extended wait times and patients leaving without being seen, a panel of nurses was formed to characterize the problem by conducting a chart review to develop potential solutions.
The chart review identified a correlation between wait times and patients leaving without being seen during hours of peak demand. Accordingly, the panel collaborated and proposed several interventions to alleviate these problems.
Formation of a panel of skilled nurses to assess problems and recommend potential solutions may represent a useful approach for active nurse participation in quality improvement in the emergency department, thus having a meaningful impact on patient outcomes and hospital liability.
护士处于独特地位，能够严格评估质量和绩效指标，识别改进机会，并在急诊科内推荐潜在的纠正干预措施。
护士可以积极推动绩效改进，提高护理质量、改善患者结局和满意度，并减少机构责任和风险。
建立一个系统的流程来识别缺陷、评估问题并制定解决方案，对于持续质量改进至关重要。
摘要
急诊科拥挤状况加剧导致需求增加，分诊时间和等待看诊时间延长，因此准确分诊比以往任何时候都更加重要，以避免患者出现不良结局和可能的医院责任问题。在一个案例中，一名75岁胸痛患者在急诊登记后但在分诊前于急诊科候诊区失去意识。尽管进行了复苏尝试，但患者未能存活。需要持续评估和改进以简化分诊流程，提高准确性和效率。由于护士在患者分诊中起着至关重要的作用，他们在评估和改进该流程方面具有独特优势。
一家乡村医院拥有18张床位的急诊科工作人员怀疑与等待时间延长和患者未就诊离开相关的潜在质量缺陷时，成立了一个护士小组，通过病历审查来描述问题并制定潜在解决方案。
病历审查发现高峰时段等待时间与患者未就诊离开之间存在关联。据此，小组合作提出了多项干预措施以缓解这些问题。
组建一个由经验丰富的护士组成的小组来评估问题并推荐潜在解决方案，可能是护士积极参与急诊科质量改进的一种有效方法，从而对患者结局和医院责任产生有意义的影响。
