Nursing Annual Report 2024 | Sailing Towards Magnet Mastery

Improving Triage Accuracy in the Emergency Department

In recent years, the Emergency Department (ED) at El Camino Health in Mountain View experienced a significant increase in both patient volume and acuity levels. The focus of the project was to identify areas where throughput could be enhanced, as measured by door to triage and door to discharge metrics.

A review of the triage process found that door to triage times were high, with triage RNs spending large amounts of time on triage questions that could also be answered by the primary RN. In collaboration with the IT Department, a Two-Step Quick Triage was created with the six categories so that a more rapid triage could be completed. The triage RN was responsible for completing the six categories, and the Primary RN was responsible for completing the remainder of the questions. Pre-implementation, the door to triage time often exceeded 17 minutes. Post-implementation, the door to triage times decreased to 12 minutes or less.

Upon review of door to triage times, a randomized audit of 400 patient charts from January-April of 2023 revealed an overall mistriage rate of 23%, with 16.25% under triaged and 6.75% over triaged. Based on these findings, the project expanded to decreasing mistriage rates with attention to under-triaged cases with potential negative impact on patient outcomes. Subsequently, the ED introduced the Emergency Nurses Association’s Emergency Severity Index (ESI) triage educational refresher course, assigned to all ED RNs. The Emergency Department conducted a post-intervention audit by reviewing an additional 400 patient charts from October to November 2023, showing further reduction in mistriage rates to 10.5%.

Significant decreases in Mountain View ED triage times and with mistriage rates underscores the effectiveness of the ED's efforts in improving triage accuracy and enhancing emergency patient care within the organization.

2023 Highlights

Throughout 2023, El Camino Health nurses disseminated new knowledge, amplified clinical leadership and practiced improvements at regional, national, and international conferences.

International presentations

• A Triplet Team M4E Journey: How the Magnet Principles Improved Our Professionalism and Became Embedded in Our Mission and Vision – panel presentation at Magnet4Europe conference (May 2023) by Jackie Keane, MSN, RN, NPD-BC, with M4E partners Penn Medicine Princeton Health, New Jersey and HH Leuven, Belgium

  

  Jackie Keane, RN with M4E partner Allison Benziger, RN poster presentation at Magnet4Europe Conference

• A Triplet Team M4E Journey – poster presentation at Magnet4Europe Conference (May 2023) by Cheryl Reinking, DNP, RN, NEA-BC, DipACLM, Jackie Keane, MSN, RN, NPD-BC, and Caroline Stewart, MSHI, RN, with M4E partners Penn Medicine Princeton Health, New Jersey and HH Leuven, Belgium
• WOW nursing! A team website by and for our nurses – poster presentation at Magnet4Europe Conference (May 2023) by Cheryl Reinking, DNP, RN, NEA-BC, DipACLM, Jackie Keane, MSN, RN, NPD-BC, and Caroline Stewart, MSHI, RN, with M4E partners Penn Medicine Princeton Health, New Jersey and AZ Sint-Maarten, Belgium
• Working as a Team to Improve Fall Rates – poster presentation at International Conference on Cancer Nursing (ICCN) (September 2023) by Shara Poppe, MSN, RN, NEA-BC, RN-BC, OCN, Alyssa Santos, BSN, RN, CMSRN, and Ann Aquino, DNP, MSN, NEA-BC, CMSRN
• Preventing Oral Mucositis to Improve Cancer-Coded Readmissions - poster presentation at ICCN (September 2023) by Shara Poppe, MSN, RN, NEA-BC, RN-BC, OCN, Kelli Lin, BSN, RN, CMSRN, Hannah Tra, BSN, RN, OCN, Alyssa Santos, BSN, RN, CMSRN, and Ann Aquino, DNP, MSN, NEA-BC, CMSRN
• Empowering the Oncology Workforce Through Education – podium presentation at ICCN (September 2023) by Ann Aquino, DNP, MSN, NEA-BC, CMSRN

National presentations

• Networking Panel and Roundtable Discussions: Former Meets Current Nurse Residents – rapid fire poster presentation at Association of Nursing Professional Development (March 2023) by Leilanie G. Apana, MSN, BSN, RN, NPD-BC
• CEUs for CNAs: Implementing the NICHE GPCA Training Program for Professional Development – podium presentation at Nurses Improving Care for Healthsystem Elders (NICHE) conference (April 2023) Jackie Keane, MSN, RN, NPD-BC, and Heather Roorda, MSN, RN, GERO-BC, NPD-BC

• Pre-Admission Services: A Nurse-Led Initiative – poster presentation at American Society of PeriAnesthesia Nurses (ASPAN) (May 2023) by Linda Boateng, MA, BSN, RN, Elma Galang, BSN, RN, PCCN, and Esther May Flores Dizon, MSN, RN, CNL

  

  Patricia DeMellopine, RN,  poster presentation at American Psychiatric Nurses Association

• Supporting the Mental Health Journey of Perinatal Women – poster presentation at American Psychiatric Nurses Association (October 2023) by Pattie DeMellopine, MSN, PMH-RN, CNS, and Antonette Lesaca, MSN, RN, CNL
• Correlates of ECT with Neurocognitive Functioning, Subjective Memory, and Depression – poster presentation at American Psychiatric Nurses Association (October 2023) by Digant Dave’ MSN, RN, PMH-BC and Katherine Taylor MD, MSc
• Multidisciplinary Team Cultivation of a Quality Same Day Discharge Program for Cardiac Cath and EP Lab Procedures - podium presentation at American College of Cardiology Quality Summit (October 2023) by Kathryn Jaramillo, MS, RN, CNS-BC, AACC; Shuwen Chen, PhD; Sian Merriot, MSN, RN-BC, CNL; Kathleen Masket, MS, RN, CNS; Linda Boateng, MA, BSN, RN; and Chad Rammohan, MD, FACC

Local and regional presentations

• Association of California Nurse Leaders (January 2023)
  • Developing Nurse Leaders Through Professional Organizations & Education – poster co-presentation by Alicia Potolsky, DNP, RN, NE-BC, DipACLM
  • Knowing Patients’ Wishes in One Click – poster presentation by Gretchen Suess, MSN, FNP, ACHPN
  • Reducing HAPIs in a Critical Care Unit – poster presentation by Sharon Howe, MBA-HCA, RN, BSN, and David Michael Gabriel, MSN, RN, CCRN
• Health Care Con (June 2023)
  • Command, Control, and Communicate: The 3 C’s of COVID – podium presentation by Cheryl Reinking, DNP, RN, NEA-BC, DipACLM,
  • Cognitive Screening in Electroconvulsive Therapy – podium presentation by Digant Dave’ MSN, RN, PMH-BC, and Brooke Schauder, PhD
  • All Together Now: Partnership for Perinatal Mental Health – podium presentation by Pattie DeMellopine, MSN, PMH-RN, CNS, and Margie Kunz, RN, MSN, CNS, C-Inpatient OB, C-EFM, NPD-BC
  • Reducing HAPIs in a Critical Care Unit – podium presentation by Sharon Howe, MBA-HCA, RN, BSN, and David Michael Gabriel, MSN, RN, CCRN
  • Saving Nurses Time by a Half Million Clicks - rapid-fire poster by Athena Lendvay, BSN, RN, OCN
  • Knowing Patients' Wishes in One Click – poster presentation by Gretchen Suess, MSN, FNP, ACHPN
  • Fostering Psychosocial Wellness in the Oncology Unit – poster presentation by Alyssa Santos, BSN, RN, CMSRN
  • Networking Panel and Roundtable Discussions: Former Meets Current Nurse Residents – poster presentation by Leilanie G. Apana, MSN, BSN, RN, NPD-BC
  • The Use of an Innovative Chat Technology to Provide Ongoing Risk Assessment to Improve Clinical Outcomes – poster presentation by L. Michelle Canfield, MSN, APRN, FNP-BC, CPAHA-TT
  • Working as a Team to Improve Falls - poster presentation by Shara Poppe, MSN, RN, NEA-BC, RN-BC, OCN, and Alyssa Santos, BSN, RN, CMSRN
  • Preventing Oral Mucositis to Improve Cancer-Coded Readmissions – poster presentation by Kelli Lin, BSN, RN, CMSRN, Hannah Tra, BSN, RN, OCN, Shara Poppe, MSN, RN, NEA-BC, RN-BC, OCN, Alyssa Santos, BSN, RN, CMSRN, and Ann Aquino, DNP, MSN, NEA-BC, CMSRN
• NorthBay Health Symposium (October 2023)
  • Sepsis Teams in the Emergency Department – podium presentation by Catherin Kan, NP, MSN, RN, FNP-C, ENP-C, DNP
  • Pre-Admission Services: A Nurse-Led Initiative – poster presentation by Linda Boateng, MA, BSN, RN, Elma Galang, BSN, RN, PCCN, and Esther May Flores Dizon, MSN, RN, CNL

Publications

Aiken, L. H., Lasater, K. B., Sloane, D. M., Pogue, C. A., Fitzpatrick Rosenbaum, K. E., Muir, K. J., McHugh, M. D., & US Clinician Wellbeing Study Consortium (2023). Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice: Factors Associated With Turnover, Outcomes, and Patient Safety. JAMA health forum, 4(7), e231809. https://doi.org/10.1001/jamahealthforum.2023.1809

Research

The Nursing Research Council (NRC) Chair Patricia DeMellopine and Co-Chair Jonathan Tong lead shared governance objectives to engage nurses in quality improvement, evidence-based practice, and research. The NRC aims to provide a supportive platform to inspire clinical inquiry, disseminate new knowledge, and innovations in nursing practice.

IRB-Approved Nurse-led Studies Completed in 2023:

• Nurses Partnering with Technology: Using Artificial Intelligence in Predicting Patient’s Risk for Falling - Principal Investigator Ann Aquino, MSN, RN, NEA-BC, CMSRN, DNP graduate of University of San Francisco (IRB Protocol 22-08)
• Evaluation of the SmartPICC System for PICC Placement in Adults - A Safety and Technical Feasibility Study – site Principal Investigator Janna Ben-Zvi, MPA, RN, VA-BC (IRB Protocol ID 21-18)
• Sepsis Team in the Emergency Department – Principal Investigator Catherine Kan, NP, MSN, RN, FNP-C, ENP-C, DNP graduate of Drexel University (IRB Protocol ID 22-19)
• Nurse-Driven Early Progressive Mobility Protocol to Decrease Length of Stay – Principal Investigator Andria Mills, RN, MSN, MBA-HCM, DNP graduate of Grand Canyon University (IRB Protocol 23-01)
• U.S. Clinician Wellbeing Study (CWS) - multi-site Principal Investigators Linda Aiken, PhD, RN, & Matthew McHugh, PhD, RN, JD, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing; site Principal Investigator Lori Story, MSN, RN, CPAN, and research coordinator Caroline Stewart, MSHI, RN (IRB Protocol ID 20-30)

IRB-Approved Nurse-led Studies Initiated in 2023

• De-Implementing Fall Prevention Alarms in Hospitals – site Principal Investigator Ann Aquino, DNP, MSN, NEA-BC, CMSRN, Co-Investigators Christine Yoo, MSN, RN, CNL, PCCN, and Stephelie Dumalag, BSN, RN, CMSRN, PCCN, and site Team Lead Caroline Stewart, MSHI, RN
• Measuring Preceptors’ Nursing Development Learning Essentials – Principal Investigator Janice Valadez, MSN, BSN, RN, DNP candidate at San Jose State University (Protocol ID 23-18)
• Saline Compresses to Reduce Nipple Pain and Nipple Injury in Breastfeeding Mothers – Principal Investigator Sasha Williams, BSN, RN, IBCLC, DNP candidate at University of Hawaii Hilo (Protocol ID 22-15)