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Children's ED staff keep families informed

Rounding creates communication
Many emergency departments (ED) struggle with the best way to keep patients informed of why they are waiting during their ED visit. Many times patients are waiting on radiology or lab testing completion; other times they may need to wait while the physician is busy with another patient in the department. Waiting can become frustrating for patients and families; and keeping patients informed of delays is an important part of increasing patient satisfaction.
Although the Children’s ED patient satisfaction scores are at the 83rd percentile, the Children’s ED staff has implemented 30-minute rounding in order to keep pediatric patients and their families better informed. Registered nurses provide rounding on patients on the hour, and clinical associates and student technicians round on the half hour. Rounding provides the  opportunity to discuss pain/discomfort, plan of care, and reasons for delay in wait.
“Every 30-minute rounding was already happening in our ED; we just had not hardwired what we were discussing with patients and families. Implementing every 30-minute rounding provided us with the opportunity to make sure all of our staff were saying the same things consistently to keep families informed,” said Julie Heckman, R.N., clinical operations coordinator for the Children’s ED and PICU.
“Keeping patients and families informed of their plan of care and why they are waiting is important to their overall comfort during the ED visit,” said Debbie Browning, RN and nurse manager of Children’s ED.
The Children’s ED will be moving in September to a new 12 bed unit, and 30 minute rounding will be moving with them into their new ED.

Students make a difference
The Children’s Hospital Quality Fellowship is a group comprised of an employee and two master of health administration students. This group recently completed their six-month, process improvement, training course given by the Quality Department.
During the fellowship, the group focused on the Press Ganey question, “How well are things working in your child’s room?” The group felt, by improving this one question, it would increase families’ comfort. During the weekly classes, the steps of the IMPROVE model were taught and led by a multidisciplinary team to implement the steps of the model concurrently with class lectures.  
This front line, multidisciplinary team (CAs, RNs, BioMed, GetWell Network representatives, etc.) met weekly to brainstorm ideas, engage other hospital groups to aid in efforts, and implement solutions. The goal was to improve the score from the 38th percentile to the 80th percentile by July.
The group narrowed the focus of the Press Ganey question to the TV and GetWell Network (GWN). Since the GWN is a large part of the TV function and a tool that is being used in patient care, the team set action plans to increase the usability and to decrease system down time. The group achieved big wins when engaging maintenance night/weekend staff. They were trained on the “quick fixes” of the system, which increase system coverage to 24/7, thus leaving no child without a functioning TV.
A second huge win was the implementation of the GWN pillow speakers. This installation eliminated the free-standing controllers, which were identified as a patient dissatisfy.
A final win is beginning at the end of May when volunteers/interns will begin patient rounds on all new admissions. These rounds will focus on “how well things are working in the child’s room.” Also the volunteer/intern will answer questions on how to work the TV/GWN.
Room orientation was a third dissatisfied that was identified by the multidisciplinary team. The group is anxious to see the July 2008 scores to see how these solutions have improved the patient experience.
Submitted by Meredith Strehle, Public Information Director for MUSC’s Children’s Hospital


Friday, May 16, 2008
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