Cargando…
Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department
Background There is a Registered Nurse (RN) shortage across the United States that is predicted to intensify in the upcoming years. RNs are an integral part of Emergency Departments (EDs) and perform many vital tasks, including IV placement, blood draws, medication administration, acute assessments,...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10367939/ https://www.ncbi.nlm.nih.gov/pubmed/37496527 http://dx.doi.org/10.7759/cureus.40926 |
_version_ | 1785077418216652800 |
---|---|
author | Heslin, Samita M King, Candice Williams, Sarah Rowe, Alison Kasschau, Mariel McMahon, Brian Morley, Eric J |
author_facet | Heslin, Samita M King, Candice Williams, Sarah Rowe, Alison Kasschau, Mariel McMahon, Brian Morley, Eric J |
author_sort | Heslin, Samita M |
collection | PubMed |
description | Background There is a Registered Nurse (RN) shortage across the United States that is predicted to intensify in the upcoming years. RNs are an integral part of Emergency Departments (EDs) and perform many vital tasks, including IV placement, blood draws, medication administration, acute assessments, and patient hand-offs. Thus, RN staffing is a crucial part of ED operations, and ED initiatives should account for RN workforce shortages. Given the increase in ED visits and crowding, throughput initiatives that can expedite patient care are integral to the functioning of an ED. Team Triage is a throughput initiative that has been shown to improve ED time to provider, length of stay, and left without being seen rates. In our institution, we created a Team Triage model where advanced practice providers (APPs) perform a patient’s initial evaluation in triage and place orders for labs, intravenous (IV) catheters, and imaging. Given the RN staffing shortage, we incorporated Licensed Practical Nurses (LPNs) in Team Triage to place IV catheters and draw blood work for laboratory tests. The objective of this investigation was to describe a Team Triage model that incorporated LPNs and to report the patient safety and productivity of this model. Methods This was a single-site retrospective study at a large, academic, tertiary care center with over 100,000 annual visits. Adult patients who self-presented to the ED and went through Team Triage (11 am-11 pm) between Jan 1, 2020, and Jan 31, 2020, were included in this study. LPNs staffed the Team Triage, along with APPs. LPNs placed IV catheters and drew blood specimens for the Team Triage patients. The primary outcomes studied were the proportion of specimens mislabeled by LPNs, the proportion of patients receiving IV catheters, the proportion of patients receiving blood work, blood tubes drawn per hour, and IVs inserted per hour in Team Triage. Results During the study period, 1355 patients went through Team Triage. Of these patients, 1075 (79%) were ordered for blood work, and 1017 (75%) were ordered for an IV catheter. All Team Triage blood work and IV catheter placements were completed by LPNs, who staffed 372 hours of Team Triage. A total of 2558 blood tubes were collected by LPNs. The LPNs cared for 2.9 patients per hour, collected 6.9 blood tubes per hour, inserted 2.7 IV catheters per hour, and collected 2.4 blood tubes per patient. The LPNs had a 0% specimen mislabeling rate. Conclusion Due to the significant RN workforce shortage impacting Emergency Medicine coupled with increased ED crowding, there is a significant need to evaluate the integration of LPNs into Team Triage to place IV catheters and perform blood draws. This study shows that incorporating LPNs in Team Triage is a productive and safe way to address nursing shortages in Emergency Medicine. |
format | Online Article Text |
id | pubmed-10367939 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-103679392023-07-26 Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department Heslin, Samita M King, Candice Williams, Sarah Rowe, Alison Kasschau, Mariel McMahon, Brian Morley, Eric J Cureus Emergency Medicine Background There is a Registered Nurse (RN) shortage across the United States that is predicted to intensify in the upcoming years. RNs are an integral part of Emergency Departments (EDs) and perform many vital tasks, including IV placement, blood draws, medication administration, acute assessments, and patient hand-offs. Thus, RN staffing is a crucial part of ED operations, and ED initiatives should account for RN workforce shortages. Given the increase in ED visits and crowding, throughput initiatives that can expedite patient care are integral to the functioning of an ED. Team Triage is a throughput initiative that has been shown to improve ED time to provider, length of stay, and left without being seen rates. In our institution, we created a Team Triage model where advanced practice providers (APPs) perform a patient’s initial evaluation in triage and place orders for labs, intravenous (IV) catheters, and imaging. Given the RN staffing shortage, we incorporated Licensed Practical Nurses (LPNs) in Team Triage to place IV catheters and draw blood work for laboratory tests. The objective of this investigation was to describe a Team Triage model that incorporated LPNs and to report the patient safety and productivity of this model. Methods This was a single-site retrospective study at a large, academic, tertiary care center with over 100,000 annual visits. Adult patients who self-presented to the ED and went through Team Triage (11 am-11 pm) between Jan 1, 2020, and Jan 31, 2020, were included in this study. LPNs staffed the Team Triage, along with APPs. LPNs placed IV catheters and drew blood specimens for the Team Triage patients. The primary outcomes studied were the proportion of specimens mislabeled by LPNs, the proportion of patients receiving IV catheters, the proportion of patients receiving blood work, blood tubes drawn per hour, and IVs inserted per hour in Team Triage. Results During the study period, 1355 patients went through Team Triage. Of these patients, 1075 (79%) were ordered for blood work, and 1017 (75%) were ordered for an IV catheter. All Team Triage blood work and IV catheter placements were completed by LPNs, who staffed 372 hours of Team Triage. A total of 2558 blood tubes were collected by LPNs. The LPNs cared for 2.9 patients per hour, collected 6.9 blood tubes per hour, inserted 2.7 IV catheters per hour, and collected 2.4 blood tubes per patient. The LPNs had a 0% specimen mislabeling rate. Conclusion Due to the significant RN workforce shortage impacting Emergency Medicine coupled with increased ED crowding, there is a significant need to evaluate the integration of LPNs into Team Triage to place IV catheters and perform blood draws. This study shows that incorporating LPNs in Team Triage is a productive and safe way to address nursing shortages in Emergency Medicine. Cureus 2023-06-25 /pmc/articles/PMC10367939/ /pubmed/37496527 http://dx.doi.org/10.7759/cureus.40926 Text en Copyright © 2023, Heslin et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Emergency Medicine Heslin, Samita M King, Candice Williams, Sarah Rowe, Alison Kasschau, Mariel McMahon, Brian Morley, Eric J Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department |
title | Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department |
title_full | Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department |
title_fullStr | Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department |
title_full_unstemmed | Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department |
title_short | Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department |
title_sort | licensed practical nurses in team triage: a safe way to address nursing shortages in the emergency department |
topic | Emergency Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10367939/ https://www.ncbi.nlm.nih.gov/pubmed/37496527 http://dx.doi.org/10.7759/cureus.40926 |
work_keys_str_mv | AT heslinsamitam licensedpracticalnursesinteamtriageasafewaytoaddressnursingshortagesintheemergencydepartment AT kingcandice licensedpracticalnursesinteamtriageasafewaytoaddressnursingshortagesintheemergencydepartment AT williamssarah licensedpracticalnursesinteamtriageasafewaytoaddressnursingshortagesintheemergencydepartment AT rowealison licensedpracticalnursesinteamtriageasafewaytoaddressnursingshortagesintheemergencydepartment AT kasschaumariel licensedpracticalnursesinteamtriageasafewaytoaddressnursingshortagesintheemergencydepartment AT mcmahonbrian licensedpracticalnursesinteamtriageasafewaytoaddressnursingshortagesintheemergencydepartment AT morleyericj licensedpracticalnursesinteamtriageasafewaytoaddressnursingshortagesintheemergencydepartment |