Running Head: EXPRESS CARE IN THE EMERGENCY ROOM 1

Express Care in the Emergency Room

Brittney Ellett

Bon Secours Memorial College of Nursing

Professional Role Development: Servant Leadership NUR 4144: Dr. Ellcessor

October 24, 2017

I Pledge
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Express Care in the Emergency Room

The goal of this paper is to identify a quality improvement project that can be

implemented utilizing the four domains of leadership and the five practices of exemplary

leadership. Quality improvement is defined as systematic and continuous actions that lead to

measurable improvement in health care services and the health status of targeted patient groups

(Quality Improvement, 2011, p. 1). There is a direct correlation between the level of improved

health services and the desired health outcomes of individuals and populations (Quality

Improvement, 2011, p. 1). In the Emergency Room, there are many quality improvement projects

and always room for growth. The implementation of hallway express care has a positive impact

for the nursing profession, patient satisfaction and outcomes. This project focuses on how to

continue to implement express care in the Emergency Department and to decrease the long

waiting times frequently seen.

A key aspect of the patients encounter at a hospital is how long he or she has to wait.

Patients still wait on average more than four hours in emergency departments (Stempniak,

2013, p. 32). There are many ways in which the Emergency Department is trying to reduce these

wait times. With the recent implementation of express care, patients are seen in chair beds

when their emergency severity index level is either a four or five. When these patients are seen,

they are generally discharged within the hour and sometimes within a few minutes. This is a vital

asset to have in the Emergency Room as it allows more patients to be seen and allows those with

less severe complaints to be seen and discharged in a timely manner.

As a nurse manager, to continue practicing and evaluating this process, it is necessary to

utilize the four domains of leadership from Lead Like Jesus, which include the heart, head,

hands, and habits. In the heart, you have to be a servant leader and not a self-serving leader. It is
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important to look at the whole picture and what is best for everyone, not just at your own

opinions. To implement the heart into express care, you have to be motivated and driven to want

this adaption to patient flow to succeed, meaning that everyone has to be on board with the plan.

The head comprises the leaders belief system and perspectives on the role of the leader

(Blanchard & Hodges, 2005, p. 83). It is important to consider the Bon Secours values and

mission statement when using the head domain and to take time to reflect on how the process is

working. In using the head, there is a time to also listen to others and value their input on the

process as well. Patients experiences through surveys and discussions are valuable to the head

domain and help model the way for better implementation of this process in decreasing wait

times.

The hands domain, or the work, is trying out this system to see if it is effective in

reducing patient wait times by helping those with less critical needs be seen and discharged

faster. A way to improve this process of express care through the work would be allowing for

better patient privacy. As it stands now, express care is done in hallway chairs with dividers

between them. Allowing more privacy and better complying with HIPPA would be beneficial to

patients being more satisfied with their care. The habits encompass strategies and spiritual habits

to help keep everyone on task for the same purpose (Blanchard & Hodges, 2005, p. 154). These

include solitude, prayer, study and application of scripture, accepting and responding to Gods

unconditional love, and involvement in supportive relationships (Blanchard & Hodges, 2005, p.

154). Being in a religious organization, it is important to make sure the habits are implemented.

Applying these habits can lead to better patient outcomes. Within habits, it is important to lead

the way. This may be comprised of modifying solutions as necessary, listening and learning to
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refine approaches, and hardwiring the improvements into daily operations through education,

training and accountability measures (Stempniak, 2013, p. 35).

Through the implementation of this process, our Emergency Department is able to model

the way for other local emergency rooms to adapt this process on their busy days. This can be

addressed at committee meetings such as the Emergency Nurses Association (ENA). By talking

about express care with other local hospitals, this allows departments to inspire a shared vision

and share their thoughts on what is going well or what is not and to improve the overall process

so that it can be standardized emergency room wide. By sharing the vision, it will allow

everyone to communicate and collaborate on the effectiveness of this process and make sure it is

being implemented on a daily basis. This will challenge the process by finding ways that our

department can grow in this area and adapt new policies for its implementation. Enabling others

to act is where upper management and coworkers will hold each other accountable to implement

this practice on a daily basis and follow through with the changes made to better the process. To

encourage the heart, it is important to build positive working relationships to increase

productivity. Practicing express care and knowing you are able to help more patients by

engaging in this practice will help you feel accomplished with your work, increasing productivity

and the bottom line.

It has been noted that ED crowding is associated with delays in care, resulting from

hospital crowding, which ultimately affects the timeliness of the ED (Handel et al., 2011, p.

1300). Something must be done to help our flow and patient satisfaction. The many inpatient

holds and high acuity levels make it hard to see patients in the waiting room, causing long

waiting times and increasing left without being seen numbers. Implementing this process has

helped to improve patient throughput, contributing to increased patient satisfaction, improved

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clinical outcomes and reduced costs (Shiver, 2007, p. 70). While these patients levels of acuity

are much lower, by having express care as an option, it demonstrates that the hospital caters to

all its patients needs (Shiver, 2007, p. 72). We have seen positive effects from starting the

express care process this year by staff and patients being better satisfied with this option, as

reflected in our press ganey comments that come out on a monthly basis.

This process is working very well in our Emergency Department. It would be interesting

to look at perspectives and implementation of express care in other local emergency rooms to see

how they view the process and what they do differently. From a patient experience, the amount

of time spent in a waiting room is very or extremely important (Stempniak, 2013, p. 31).

Express care helps to alleviate the wait time for some patients who are having to wait hours

before being seen due to their acuity level and the fact that there are no open beds. To continue

the effectiveness of this quality improvement project, it is important to make waiting times a

priority, being transparent with patients about what is causing wait times, and engaging patients

and families in their care as key factors (Stempniak, 2013, p. 35).

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References:

Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.

Handel, D., Epstein, S., Khare, R., Abernethy, D., Klauer, K., Pilgrim, R., . . . Sayan, O. (2011).

Interventions to improve the timeliness of emergency care. Academic Emergency

Medicine, 18, 12951302. doi:10.1111/j.1553-2712.2011.01230.x

Quality improvement. (2011). U.S. Department of Health and Human Services Health Resources

and Services Administration. 1-17. Retrieved from

https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf

Shiver, J. J. (2007). ED performance improvement: Process changes hospitals can make now.

Healthcare Financial Management: Journal of the Healthcare Financial Management

Association, 61(12), 70-73).

Stempniak, M. (2013). What, no wait? Can hospitals make that happen? Hospitals & Health

Networks, 87(11), 31-35.