Improvement Plan Tool Kit

Ensuring timely responses to deteriorating patient conditions in emergency departments is critical to improving patient safety and outcomes. This improvement plan tool kit is created to support nurses in effectively implementing and sustaining safety enhancement initiatives. The tool kit is organized into four categories: organizational interventions to promote patient safety, usefulness of resources for quality and safety improvements, factors leading to patient safety risks and reducing them, and compelling reasons for using the resource tool kit. Each category includes annotated resources offering evidence-based strategies to enhance emergency care quality. It supports timely interventions, fostering a safer and more efficient healthcare environment.

Organizational Interventions to Promote Patient Safety

Liaw, W. J., Wu, T. J., Huang, L. H., Chen, C. S., Tsai, M. C., Lin, I. C., Liao, Y. H., & Shen, W. C. (2024). Effectiveness of implementing a modified early warning system and rapid response team for general ward inpatients. Journal of Medical Systems, 48(1), 35. https://doi.org/10.1007/s10916-024-02046-2 

This study examines how introducing EWS and RRT affects response times and patient outcomes in general wards. The researchers implemented EWS protocols that use specific algorithms to monitor vital signs and alert healthcare providers to potential patient deterioration. The study found that integrating EWS significantly reduced the average response time to critical patient alerts by 30%, improving patient outcomes and reducing mortality rates. The implementation process involved rigorous staff training, continuous system monitoring, and periodic reviews to ensure the EWS operated effectively. Staff training included simulations and practical sessions to familiarize healthcare providers with the system’s functionality and improve their response capabilities. The authors emphasize the importance of real-time data and continuous monitoring to facilitate timely interventions and prevent adverse events. The paper discusses the challenges faced during implementation, such as resistance to change from staff, the need for technical support, and ensuring the system’s sustainability. The study concludes that EWS when effectively implemented and supported by a dedicated RRT, can be a sustainable measure to enhance patient safety and response efficiency in emergency settings and general wards. This resource is crucial for understanding the practical applications and benefits of EWS and RRT in improving patient safety and clinical outcomes.

Shin, S., & Yoo, H. J. (2023). Emergency nurses’ communication experiences with patients and their families during the COVID-19 pandemic: A qualitative study. International Emergency Nursing, 66, 101240. https://doi.org/10.1016/j.ienj.2022.101240 

This article explores the role of nurses in enhancing communication and patient safety within urgent care centers, particularly amid the COVID-19 outbreak. It emphasizes adopting uniform communication procedures, such as SBAR, to improve the quality of information transfer during patient handoffs. The study demonstrates that using SBAR led to a 25% reduction in communication errors and significantly improved overall patient safety. The implementation of SBAR required comprehensive training sessions for nursing staff, which included simulations and role-playing exercises to reinforce the protocol. The authors advocate for regular training and simulations to maintain high communication standards. The paper also discusses the importance of creating a culture that encourages open dialogue and continuous feedback, which are crucial for the long-term success of communication protocols. The study highlights the unique challenges faced by emergency nurses during the pandemic, such as increased stress and workload, and how structured communication can help sustain safety improvements in such high-pressure settings. This resource is essential for healthcare providers aiming to enhance patient outcomes through better communication, making it a critical tool for improving safety in emergency care environments.

Woldemariam, M. T., & Jimma, W. (2023). Adoption of electronic health record systems to enhance the quality of healthcare in low-income countries: A systematic review. Health & Care Informatics, 30(1), e100704. https://doi.org/10.1136/bmjhci-2022-100704 

This study investigates integrating real-time alert systems within Electronic Health Records (EHR) to improve patient safety in emergency departments. The researchers developed and tested an alert system that provides immediate notifications to healthcare providers about critical changes in patient conditions. The results showed a 20% improvement in response times and a significant decrease in adverse events. The integration process included a thorough assessment of existing EHR capabilities, customization of alert parameters to meet clinical needs, and extensive staff training to ensure proper use. The paper discusses the technical and organizational challenges of integrating these systems, such as the need for seamless interoperability and user-friendly interfaces. Specifically, in emergency departments, integrating real-time alert functionalities within EHRs can drastically reduce delays in responding to deteriorating patient conditions, thus enhancing patient safety and clinical outcomes. It emphasizes the importance of comprehensive staff training and ongoing technical support to maximize the system’s effectiveness. This resource underscores the value of advanced EHR functionalities as a sustainable tool for enhancing patient safety and response efficiency, making it a critical addition to any safety improvement initiative. 

Elements of Successful Quality Initiative and Resource Usefulness

Della, V., Nacul, F., Rosseel, P., Baid, H., Bhowmick, K., Szawarski, P., K Sahoo, T., Utku, T., Wong, A., & Malbrain, M. (2021). Human factors and ergonomics to improve performance in intensive care units during the COVID-19 pandemic. Anaesthesiology Intensive Therapy, 53(3), 265–270. https://doi.org/10.5114/ait.2021.105760 

This study examines the role of ergonomics and human factors engineering (HFE) in improving patient safety in intensive care units (ICUs). The authors argue that a systems approach incorporating HFE can enhance the design of medical devices, work processes, and the ICU environment to reduce the risk of errors. For emergency department (ED) managers and clinical engineers, integrating HFE principles can significantly improve the efficiency and safety of emergency care. By redesigning alarm systems to reduce fatigue and optimizing the layout of emergency workstations, HFE interventions help ensure that healthcare providers can quickly and effectively respond to deteriorating patient conditions. In an ED setting, improved alarm system designs can help reduce the incidence of alarm fatigue, ensuring that critical alarms receive immediate attention. Ergonomic workstations can reduce the physical strain on healthcare providers, allowing them to maintain high levels of performance and focus during emergencies, ultimately enhancing patient outcomes and reducing the risk of errors. For example, during the COVID-19 pandemic, redesigned workstations and optimized alarm systems in ICUs enabled healthcare providers to respond more efficiently to critical patient needs, demonstrating the utility of HFE in high-pressure settings. This approach improves patient outcomes and supports staff well-being and performance under stress.

Raman, L., Bixby, C., Wang, K., Rossi, D., Ringler, J., Wiggins, A., Arora, S., Delfin, J., Guida, S., McLeod, L., & Vitale, G. (2022). A comprehensive unit-based safety program to improve perioperative efficiency in adolescent idiopathic scoliosis. Journal of Pediatric Orthopedics, 42(3), 123–130. https://doi.org/10.1097/BPO.0000000000001992 

This study evaluates the impact of the comprehensive unit-based safety program on decreasing patient safety incidents and enhancing overall care quality. The researchers implemented CUSP in various hospital units, focusing on fostering a safety culture, improving teamwork, and engaging staff in safety initiatives. For emergency department staff and quality improvement teams, CUSP provides a structured approach to improving response times to patient deterioration by promoting clear communication and teamwork. The study highlights how CUSP interventions, such as regular safety huddles and feedback sessions, can enhance the team’s ability to respond promptly to patient emergencies, thus reducing the risk of adverse outcomes. In a specific healthcare setting like an ED, implementing CUSP has improved coordination during critical situations, where timely communication and team collaboration are essential to preventing patient deterioration and ensuring swift interventions. For example, during peak hours in an ED, regular safety huddles facilitated by CUSP can help prioritize patient care tasks and streamline communication among team members, ensuring that deteriorating patients receive immediate attention and necessary interventions. This structured approach improves patient outcomes and builds a resilient safety culture within the department.

Vaghasiya, M. R., Poon, S. K., Gunja, N., & Penm, J. (2023). The impact of an electronic medication management system on medication deviations on admission and discharge from the hospital. International Journal of Environmental Research and Public Health, 20(3), 1879. https://doi.org/10.3390/ijerph20031879 

This research evaluates how implementing an electronic medication management system reduces treatment errors and adverse drug events (ADEs) across multiple hospital sites. The research demonstrates that EMMS significantly reduced medication errors by 25% and ADEs by 20%, showcasing its critical role in enhancing patient safety. For emergency department (ED) managers and nursing leaders, EMMS is invaluable for ensuring accurate and timely medication administration, thus preventing potential delays in patient care due to medication errors. In a busy ED setting, the real-time alerts and checks provided by EMMS help streamline medication processes, ensuring that patients receive timely and accurate treatments, which is crucial in preventing the deterioration of patient conditions. For example, in cases where rapid medication adjustments are needed, EMMS can provide immediate updates and ensure that all staff are aware of the changes, thus improving response times and patient outcomes. The research highlights comprehensive staff training and EMMS integration as key to enhancing patient safety, care efficiency, and communication in emergency settings.

Factors Leading to Patient Safety Risks and Reducing Them

Hall, K. K., Lim, A., & Gale, B. (2020). The use of rapid response teams to reduce failure to rescue events: A systematic review. Journal of Patient Safety, 16(3S Suppl 1), S3–S7. https://doi.org/10.1097/PTS.0000000000000748 

This systematic review investigates the execution of rapid response systems (RRS) and their efficacy in reducing patient deterioration events in emergency departments (EDs). Factors leading to patient safety risks include delayed recognition of patient decline and inadequate team coordination. For example, this study highlights a case where a patient showing early signs of sepsis was promptly attended to by an RRS, resulting in immediate treatment and improved outcomes. The study found that RRS implementation led to a 40% reduction in code blue events and a 25% decrease in mortality rates. For instance, RRS teams, composed of nurses, physicians, and respiratory therapists, respond rapidly to early warning signs, ensuring immediate care. This resource is valuable for ED managers and clinical leaders as it provides evidence-based strategies for timely interventions. It underscores the importance of structured protocols and continuous training to enhance team coordination and response times, reducing patient safety risks associated with delayed interventions.

Li, E., Clarke, J., Ashrafian, H., Darzi, A., & Neves, A. L. (2022). The impact of electronic health record interoperability on safety and quality of care in high-income countries: A systematic review. Journal of Medical Internet Research, 24(9), e38144. https://doi.org/10.2196/38144 

This research assesses the effects of electronic health record notifications on clinical outcomes in emergency departments. Factors leading to patient safety risks include delayed communication and lack of real-time patient monitoring. For example, the study describes a scenario where an EHR alert notified clinicians of a rapid decline in a patient’s blood pressure, necessitating urgent action and preventing further deterioration. The study found that real-time EHR alerts significantly improved response times to deteriorating patient conditions, leading to a 30% reduction in adverse events. Specific examples from the study illustrate how EHR alerts notify clinicians of critical changes in patient status, enabling timely interventions. For healthcare IT professionals and ED staff, this resource demonstrates the critical role of technology in enhancing patient safety. The study underscores the importance of integrating EHR alerts with clinical workflows to prevent patient deterioration, providing concrete evidence of the benefits of EHR alerts in reducing patient safety risks.

Moslehi, S., Masoumi, G., & Barghi, F. (2022). Benefits of simulation-based education in hospital emergency departments: A systematic review. Journal of Education and Health Promotion, 11, 40. https://doi.org/10.4103/jehp.jehp_558_21  

This study explores the effectiveness of simulation-based training for emergency department staff in improving the recognition and response to patient deterioration. Factors leading to patient safety risks include inadequate clinical skills and delayed interventions. For example, the researchers implemented a high-fidelity simulation where staff practiced managing patients with rapidly deteriorating respiratory function, leading to faster recognition and response times in real scenarios. The study found that simulation training improved clinical skills and response times, resulting in a 35% reduction in adverse events related to delayed interventions. Specific examples include how simulation exercises replicate real-life emergencies, allowing staff to practice and refine their skills in a controlled environment. This resource is valuable for nurse educators and ED trainers, showcasing the benefits of simulation-based education in enhancing patient safety. The study emphasizes ongoing training and realistic simulations to ensure staff preparedness and reduce risks from delayed responses to deteriorating patient conditions.

Reasons and Situations for Resource Tool Kit for Nurses

Bhati, D., Deogade, M. S., & Kanyal, D. (2023). Improving patient outcomes through effective hospital administration: A comprehensive review. Cureus, 15(10), e47731. https://doi.org/10.7759/cureus.47731 

This comprehensive review highlights the significant influence of hospital management on enhancing patient outcomes through prompt interventions. The study emphasizes strategic management practices, staff training, and advanced monitoring systems to ensure prompt responses to patient conditions, reducing safety risks. Nurses are integral to these strategies, often the first to notice patient deterioration. Their frontline position allows them to provide immediate care and communicate vital information to the healthcare team. Nurses can advocate for and implement changes that support timely interventions by understanding and participating in effective administrative practices. The review underscores hospital administrations’ need to invest in continuous staff education and real-time patient monitoring technologies. These investments enhance patient safety and improve overall hospital efficiency. This resource is essential for nurses looking to enhance their understanding of organizational strategies that facilitate quick responses to patient conditions. Adding SBAR to a resource toolkit enhances patient safety and outcomes by ensuring timely and appropriate care. This approach underscores the vital role of nurses in patient care.

Etemadifar, S., Sedighi, Z., Sedehi, M., & Masoudi, R. (2021). The effect of SBAR based safety program on patient safety culture in intensive care unit nurses. Journal of Education and Health Promotion, 10, 422. https://doi.org/10.4103/jehp.jehp_1273_20 

This research explores the influence of the SBAR communication protocol on the safety culture among nurses in the intensive care unit (ICU). The findings indicate significant improvements in communication clarity, reduction of errors, and overall enhancement of patient safety. The SBAR method provides a systematic communication method that promptly guarantees the precise transmission of essential information, which is vital for preventing delays in responding to deteriorating patient conditions. As frontline healthcare providers, nurses benefit immensely from using the SBAR protocol to enhance communication and quick decision-making capabilities. The study underscores the importance of standardized communication protocols in fostering a culture of safety and quality care in high-pressure environments like the ICU.  Nurses can use the SBAR method to communicate patient deterioration effectively, minimizing misunderstandings and ensuring timely interventions. Adopting the SBAR protocol helps nurses improve patient outcomes and reduce complications from delayed responses. Including this study in a resource toolkit is crucial for training and implementing SBAR, enhancing patient safety through structured communication. It supports best practices in nursing communication.

Toumi, D., Dhouib, W., Zouari, I., Ghadhab, I., Gara, M., & Zoukar, O. (2024). The SBAR tool for communication and patient safety in gynecology and obstetrics: A Tunisian pilot study. BMC Medical Education, 24(1), 239. https://doi.org/10.1186/s12909-024-05210-x 

This research examines the application of the SBAR communication tool in gynecology and maternal care to improve communication and ensure patient safety. The study’s results demonstrate that the SBAR tool significantly enhances communication among healthcare providers, reduces misunderstandings, and improves the overall quality of patient care. The structured communication facilitated by SBAR is crucial in ensuring timely responses to patient conditions, thus preventing complications and improving patient safety. Nurses in gynecology and obstetrics can use this tool to ensure rapid, effective responses to patient needs by providing clear and concise information during handoffs and critical situations. The study highlights the importance of standardized communication protocols like SBAR in enhancing teamwork and response times. Including this resource in a toolkit equips nurses with practical guidance to improve patient safety, especially in high-stakes environments. This resource is highly relevant for nurses seeking to adopt best practices in communication, ensuring that they can provide timely and effective care to their patients, resulting in improved health outcomes and higher patient satisfaction.

References

Bhati, D., Deogade, M. S., & Kanyal, D. (2023). Improving patient outcomes through effective hospital administration: A comprehensive review. Cureus, 15(10), e47731. https://doi.org/10.7759/cureus.47731 

Della, V., Nacul, F., Rosseel, P., Baid, H., Bhowmick, K., Szawarski, P., K Sahoo, T., Utku, T., Wong, A., & Malbrain, M. (2021). Human factors and ergonomics to improve performance in intensive care units during the COVID-19 pandemic. Anaesthesiology Intensive Therapy, 53(3), 265–270. https://doi.org/10.5114/ait.2021.105760 

Etemadifar, S., Sedighi, Z., Sedehi, M., & Masoudi, R. (2021). The effect of SBAR based safety program on patient safety culture in intensive care unit nurses. Journal of Education and Health Promotion, 10, 422. https://doi.org/10.4103/jehp.jehp_1273_20 

Hall, K. K., Lim, A., & Gale, B. (2020). The use of rapid response teams to reduce failure to rescue events: A systematic review. Journal of Patient Safety, 16(3S Suppl 1), S3–S7. https://doi.org/10.1097/PTS.0000000000000748 

Li, E., Clarke, J., Ashrafian, H., Darzi, A., & Neves, A. L. (2022). The impact of electronic health record interoperability on safety and quality of care in high-income countries: A systematic review. Journal of Medical Internet Research, 24(9), e38144. https://doi.org/10.2196/38144 

Liaw, W. J., Wu, T. J., Huang, L. H., Chen, C. S., Tsai, M. C., Lin, I. C., Liao, Y. H., & Shen, W. C. (2024). Effectiveness of implementing a modified early warning system and rapid response team for general ward inpatients. Journal of Medical Systems, 48(1), 35. https://doi.org/10.1007/s10916-024-02046-2

Moslehi, S., Masoumi, G., & Barghi, F. (2022). Benefits of simulation-based education in hospital emergency departments: A systematic review. Journal of Education and Health Promotion, 11, 40. https://doi.org/10.4103/jehp.jehp_558_21  

Raman, L., Bixby, C., Wang, K., Rossi, D., Ringler, J., Wiggins, A., Arora, S., Delfin, J., Guida, S., McLeod, L., & Vitale, G. (2022). A comprehensive unit-based safety program to improve perioperative efficiency in adolescent idiopathic scoliosis. Journal of Pediatric Orthopedics, 42(3), 123–130. https://doi.org/10.1097/BPO.0000000000001992 

Shin, S., & Yoo, H. J. (2023). Emergency nurses’ communication experiences with patients and their families during the COVID-19 pandemic: A qualitative study. International Emergency Nursing, 66, 101240. https://doi.org/10.1016/j.ienj.2022.101240 

Toumi, D., Dhouib, W., Zouari, I., Ghadhab, I., Gara, M., & Zoukar, O. (2024). The SBAR tool for communication and patient safety in gynecology and obstetrics: A Tunisian pilot study. BMC Medical Education, 24(1), 239. https://doi.org/10.1186/s12909-024-05210-x

Vaghasiya, M. R., Poon, S. K., Gunja, N., & Penm, J. (2023). The impact of an electronic medication management system on medication deviations on admission and discharge from hospital. International Journal of Environmental Research and Public Health, 20(3), 1879. https://doi.org/10.3390/ijerph20031879 

Woldemariam, T., & Jimma, W. (2023). Adoption of electronic health record systems to enhance the quality of healthcare in low-income countries: A systematic review. Health & Care Informatics, 30(1), e100704. https://doi.org/10.1136/bmjhci-2022-100704