Conference Summaries 2020

Keynote address by Renee Thompson.

Renee challenged the entire room to relish the reasons we all became nurses in the first place. While we are frequently referred to as angels and/or heroes, as nurses we downplay that thought because this is what we do. Instead we need to embrace that and use our powers to influence others in positive ways. She also challenged us to have our “game” face on whenever we walk across the threshold into our place of work. Continuously learn and educate ourselves so that we can enhance our colleagues professional life. Lastly, we need to take care of ourselves and have some fun. Renee demonstrated through her personal stories how honorable and respected nurses truly are and that we need to conduct “laugh yoga” during our daily huddles. We really are heroes by choice and need to celebrate all of our successes.

The Impact of Centralized Operations Team (COT) on Discharge Before Noon (DBN)

Dr. Nelson Tuazon presented the performance improvement project at his facility that underscores patient throughput as a critical organizational imperative. The primary focus was on the implementation of a structured discharge planning process from the day of admission. The Centralized Operations Team (COT) approach was showcased, along with technology, for immediate escalation of discharge barriers through collaborative communication. Prior to the project, staff from environmental services (EVS), patient transport, staffing office, and the patient placement were located in different locations. These staff members were moved to a centralized location while remaining under their cost centers. Dr. Tuazon shared that Appreciative Inquiry (AI) was utilized to analyze the current state, define the ideal state, design the improvement plan, and establish future state.

The Leading and lagging indicators included for this project included Discharges Before Noon (DBN), LOS, and readmission rates. The goal was to achieve a sustainable DBN target of 25% or better without an increase in patient’s LOS. The participants will understand the use and importance of AI as an effective performance improvement tool. The participants will recognize that structured discharge planning process, supported by an organized COT, a target DBN of 25% or greater can be achieved without increasing the patient LOS. The practical applications of the Centralized Operations Team are promising. University Health System has sustained a hospital-wide DBN of close to 28% (up from about 12to 16% the year before) after a year of implementation. Nursing, ancillary services, patient placement staff, case management, physicians, and hospital leaders are key to the success of this initiative.

For more information, please read A Patient-Centered Approach on Discharge before Noon: A Paradigm Shift at https://www.naylornetwork.com/tne-nwl/newsletter-v2.asp?issueID=65456

 The Nurse Leader’s Role in Crisis Management

Amy Daher, Associate Chief Nursing Officer at University Medical Center of El Paso, shared the role her facility played during the tragic shooting in El Paso, Texas on August 3, 2019. University Medical Center (UMC) is an Academic, Safety Net, Level 1 Trauma hospital in El Paso, Texas. UMC is the only Level 1 trauma center within a 280-mile radius serving 1.5 million patients per year.

On August 3, 2019 Amy Daher received a phone call from her House Supervisor at UMC stating there was an active shooter at the Wal-Mart down the street from the hospital with multiple casualties. This was a moment the team had prepared for in simulations but never thought they would ever implement. Amy made her way to the hospital, contacted her leadership team, and opened the Incident Command Center (ICS). Multiple phone calls were made to staff asking them to come in and help. This was an all hands-on deck situation and none of them hesitated to stop what they were doing to come in and help. Many staff members were calling the hospital on their own asking if help was needed.

Within 34 minutes the hospital received 14 patients. There were 22 patients who died at the scene. When looking back on this day, Daher states that the training her facility did to prepare for events like this was critical and turned a tragic event into something they could be proud of.

In retrospect, the most important component to managing the chaos that ensued was communication. Constant and consistent communication was critical to keeping families informed, knowing and understanding what was unfolding at the crime scene, and preparing for what could possibly come into their facility. There were multiple family members looking for their loved ones. At one time, there were reports of multiple shooters and a terrorist attack. The team needed to prepare for the possibility of treating the shooter. This would mean the facility would be on lockdown and communication would need to be minimized so the shooters location would remain unknown. The open lines of communication allowed first responders, community leaders, and UMC to stay calm, organized, and ultimately care for their community.

What the team did not anticipate was the aftermath of high-profile visitors who came to El Paso and UMC. President Trump, Beto O’Rourke, U.S. senators and representatives, Mexican consulates, actors, singers, and the media were all wanting to talk with the victims and their families. The team had to be mindful of patient privacy and take the appropriate measures to ensure they were protected.

Post-recovery efforts ensued within days after the shooting. The hospital received an outpouring of support from people across the country and the world by sending goodies and banners indicating they stood with them and were there for them. The hospital leadership team and community leaders were most concerned about their staff. They partnered with community resources to provide long term recovery and help staff cope with post-traumatic stress disorder. They worked with their Employee Assistance Program to extend the number of sessions allowed for staff to use.

When reflecting on August 3rd, Daher indicated there were key areas nurse leaders should focus on when preparing for events like this one. Readiness education and simulation in crisis management and planning is key. You must develop a solid plan and validate the effectiveness of that plan. Know your resources and their availability. How will you communicate with critical players, including staff to deploy resources efficiently and effectively? Media relations training is an important competency for all nurse leaders to have. Take the Systems Theory approach and engage stakeholders, both community and government early all while focusing on the inputs and outputs of the system.

Daher took away key learnings through this experience as well. She learned during tragic events; people will rise up to lead. The phrase, “play like you practice” allowed the team to successfully communicate and coordinate with appropriate stakeholders to include the El Paso Trauma System and the Texas Trauma system. Both entities were key players in the success of that day and proved the systems work to our advantage. The most important take away for Daher though was making sure the staff providing care to the victims were taken care of. They were true heroes that day.

 Managing Nursing Cognitive, Documentation, and Communication Burden in Complex Information Systems - Mary Beth Mitchell, RN, MSN, BC, CPHIMS

There is burden of documentation in the current complex healthcare environment. Cognitive burden is related to cognitive overload and ongoing working memory in nursing practice, resulting in shortcuts and less detail in documentation. Patients may experience less “nursing presence” as alarms, procedures, protocols, and deadlines compete. Most alarms are not actionable, which may cause nurses to overlook necessary actions. Mental offloading occurs as a natural coping method.

The impact of cognitive burden includes distraction, errors, over-reliance on technology and isolated workflows. There is scattered information in the electronic health record which makes it difficult to prioritize. Nurses find it difficult to find important information. Medical devices are not commonly synthesized, requiring nurses to use unnecessary time and energy away from patients. They must overly rely on their working memory.

Reducing cognitive burden requires communication tools to be context specific. Information should be synthesized and integrated. Alarms could be managed by changing parameters to be meaningful guides in nursing prioritization. Utilizing predictive models in clinical decision-making empowers accurate and efficient care giving. Integrated monitors enhance meaningful analysis of data in real-time. Synthesized, integrated data should be available to staff, which reduces cognitive burden of nursing practice.