Intervention Title:
Reducing Time for Admission Through Team Process– Prairie Lakes Healthcare System, Watertown, S.D.

Goal:
Improve admission process timeliness and reduce staff stress.

Intervention:
Staff established a resource nurse position to work in partnership with a medical/surgical nurse for each admission.

Result:
The speed of the admissions process increased and the teams became more integrated.

Institution:
Prairie Lakes Healthcare System
401 Ninth Avenue, N.W.
Watertown, SD 57201
P: (605) 882-7000

From the C-Suite:
“We understand how important it is for a patient being admitted to a unit to be settled and made comfortable as quickly as possible. By taking a new team approach with a resource nurse to partner with the bedside nurse, we have greatly improved staff and patient satisfaction while saving everyone time.”

Jill Fuller, R.N., Ph.D.
Chief Nursing Officer
Prairie Lakes Healthcare System

Profile:
Prairie Lakes Healthcare System is an 81-bed hospital serving seven rural counties in northeastern South Dakota.

Clinical areas affected:

• Medical/surgical units

Staff involved:

• Resource nurse
• Staff nurse
• Pharmacist

Timeline:
After a one-week pilot, the program was fully operational in 2003.

Contact:
Jill Fuller, R.N., Ph.D.
Chief Nursing Officer
P: (605) 882-7670
fullerj@prairielakes.com

Intervention implementation:
At Prairie Lakes Healthcare System, admitting new patients to the medical/surgical unit had evolved into a time-consuming task that was taking away from patient care. In order to improve the process, a new role was created for a resource nurse and the traditional charge nurse role was eliminated. The resource nurse served as a partner to the medical/surgical nurse for every admission and provided the clinical expertise to bedside nurses. Admission documentation was streamlined to reduce time involved.

To further improve the process, the team considered how a unit prepares for admission. Now all nurses carry walkie-talkies so the resource nurse can work with the team, assess the climate on the unit and determine the best place for a patient based on current work intensity.

Once the resource nurse puts out a call to the unit that a patient is going to be placed in a specific room with a particular nurse, the rest of the team is immediately aware of who needs coverage and support while the admission takes place. Prairie Lakes defines admission from the time a patient arrives on the unit to the time all major orders are addressed.

Once the patient arrives on the unit, a two-person team is awaiting their arrival and a room is prepared and ready. One nurse does the physical exam and another does the admission interview with a laptop in the room. A pharmacist on the floor who is part of the admission team ensures that any immediate medications ordered are delivered to the bedside. The process ensures patients are quickly and comfortably placed in a room with all immediate needs met.

Advice and lessons learned:

1. Eliminate the charge nurse for the resource nurse. Thischallenged bedside nurses to be more active managers of patient care and elevated their practice. Since there was no additional cost to the new process, it was sustainable.
2. Focus on patient-centered care. Time saved resulted in more time to focus on the patient and address their needs more quickly.

Cost/benefit estimate:
Benefits include eliminated overhead positions, improvement in productivity and a reduction in the admissions process from 90 to 15 minutes 75 percent of the time.