The Effect of a Nursing Hold Team on Patient Satisfaction for Admitted Patients Discharged Directly From the Emergency Department.

Brittany Choe,Bartholomew Cambria,Kurien Mathews,Nicole Berwald,Mikhail Podlog,Elias Youssef,Barry Hahn,Joseph Basile

doi:10.7759/cureus.17100

Abstract

Objectives: Emergency departments (ED) across the United States face challenges related to patient volume, available capacity, and patient throughput. Patient satisfaction is adversely affected by crowding and lengthy boarding times. This study aimed to determine whether the implementation of a dedicated nursing hold team (NHT) would improve patient satisfaction scores for admitted patients discharged directly from the ED.Methods: This was a retrospective, observational study with a pre-/post-test design. All admitted adult patients who returned a Press Ganey (PG) survey were included in the study. There were two twelve-month study periods before and after implementing an ED NHT. The primary outcome was the percentage of patients who gave top box scores for all questions in the Nursing Communication Domain.Results: During the pre-implementation period, 108 patients (59%) gave an overall top box rating for the Nursing Communication Domain versus the post-implementation period, where 99 patients (66%) provided a top box rating (OR 1.375, p = 0.16). There was a trend toward increased satisfaction for individual categories. However, these differences were not statistically significant.Conclusions: Implementing a dedicated NHT showed an increase in the overall top box PG Nursing Communication Domain score and several of the individual domain questions. Future studies should examine other potential benefits from a dedicated NHT, such as the rate of adverse events and medication delays.

Highlights

Emergency departments (ED) across the United States face daily challenges related to patient volume, available capacity, and overall patient throughput
The goal of this study was to determine whether the implementation of an nursing hold team (NHT) would improve patient satisfaction scores for admitted patients discharged directly from the ED
During the pre-implementation period, 2714 subjects were identified as holds. 182 subjects from this group were discharged directly from the ED and subsequently completed a Press Ganey (PG) survey

Summary

Introduction

Emergency departments (ED) across the United States face daily challenges related to patient volume, available capacity, and overall patient throughput. ACEP defines a “boarded patient” as a patient who remains in the ED after the patient has been admitted or placed into observation status at the facility, but has not been transferred to an inpatient or observation unit. This cohort introduces many logistical and staffing constraints that must be navigated daily. Boarders have higher rates of medication delays and adverse events [1,2,3] Both treat and release and admitted patient satisfaction is adversely affected by ED crowding, prolonged ED hallway time, and lengthy boarding times [4,5]

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