Transport of Telemetry Patients
Transport of telemetry patients from the Emergency Department(ED) to the admit room by a Registered Nurse has been the routine in the past. This requires the ED nurse to interrupt her already busy work load and escort a patient out of the ED to the new assigned room. Depending on the location of the admit floor, this can be very time consuming. This causes an increased patient ratio for the nurse left to watch over the remaining patients. In our facility, the current patient ratio is 4 patients to 1 nurse. When a nurse is off the floor transporting a patient, he/she leaves the three other patients to a fellow nurse, increasing that nurse’s ratio to 7 patients. This increased patient load can be overwhelming to that remaining nurse and can lead to medication errors. Nurses have asked that for the low risk telemetry patients, licensed ACLS certified paramedics transport them to their admit bed. Clinical Educators and Management has agreed that this can provide some relief to the transport of low risk telemetry patients.
As discussed in part one of this change, realization that there is a need for change must be present as well as acceptance to a change. The ED nurses have met with the management team and discussed the proposed change. The Director of the ED has agreed to present the plan to the governing committees to obtain approval. Last week, the Director informed us that approval has been granted for ED techs with current ACLS and paramedic licensure to begin education for this new role. We discussed this possible upcoming change with a group of paramedics and believe that it was well accepted. According to Olgesby (2007), EMT-Paramedics can provide interventions such as urinary catheterization, patient transport, point of care testing and contribute to the provision of emergency care. This can be very useful in decreasing the workload for the RN. By utilizing the ED techs to transport low risk telemetry patients to their admit units, patient flow and ED throughput will be improved. This can also help increase nurse satisfaction and in turn increase patient satisfaction. “ EMT-Ps in a supportive role, when utilized appropriately and in conjunction with clear written guidelines, can have a major impact in the everyday burdens of RNs in the emergency department, allowing them more time to guide and direct overall patient care initiatives” (Olgesby,2007 p 25). The plan was presented to the ED techs and to the nurses in a staff meeting. Overall acceptance and positive attitudes towards the new change was noted. Nurses are grateful that this role has been approved and feel that this will allow for more time to provide care to their patients. ED techs expressed that this will allow them more responsibility and camaraderie. Management and RNs feel that by decreasing the amount of time nurses are interrupted to escort a patient out of the ED, the ED Throughput Core Measure and the ED Length of Stay (LOS) will greatly improve.
Overall consensus was to hold weekly in services with the ED techs for a month in order to discuss policies and review important ACLS guidelines. ED techs have been asked to provide topics that they feel they need to go over. The majority felt that arrhythmia review was a necessary area for review. Email will be used for easy communication with ED techs. Our facility has a great resource for all staff which we plan to utilize. There are arrhythmia courses available as well as other online classes that will help educate the ED techs. Management has also set up meeting with managers of other departments to discuss the upcoming change. It is important that there be open communication with other departments and that any possible issues be addressed.
Research and Studies. Research was done and found that there have been studies done in the past on this topic. According to Gilboy and Tanabe (2006),…