Peer Review

• Respond to a minimum of two peers’ posts. What additional quality and safety resources can you find that relate the project identified in your peers’ post? (cite!) How does the project your peer identify compare to the project you identified at your place of employment?

Review 1: My place of employment is a Labor and Delivery unit and after exploring the various resources that AHRQ has listed for patient safety and speaking with the unit’s nurse manager, I’ve noticed that quite a few are used in the QI initiative at the L&D unit I work on. I think one of the biggest QI initiatives I learned my unit has implemented is use of NEST fetal remote monitoring. NEST stands for Neonatal Outcomes Impacted by Escalation Safety Telemetry and what it is, is a remote fetal monitoring hub that is watched by other L&D nurses to view fetal heart patterns and contraction patterns in real time in order to catch possible abnormalities early and address them. The implementation of NEST has helped to catch fetal distress early and improve not only neonatal, but maternal outcomes. The AHRQ patient safety resources I explored that support this are TeamSTEPPS and CUSP in AHRQ’s Perinatal Safety Toolkit. One of the focuses of TeamSTEPPS is situation monitoring, and this is exactly one of the goals of NEST- real time monitoring of fetal heart patterns and contractions and notification if something abnormal or concerning is found. One of the focuses of CUSP is identifying safety risks. This relates directly to NEST as well because NEST helps to identify abnormal patterns early.

Review 2: The quality improvement initiative at my work place that I am choosing to focus on is how to reduce overcrowding in the emergency department. I reviewed the policies and procedures forum from Lancaster general hospital and found that they have implemented procedures to help with the flow of patients coming through the emergency department. Patients are initially triaged when they arrive and given an acuity rating and this determines when they will be seen. Higher acuity patients such as a cardiac arrest or STEMI would be seen first as they are a level one acuity. Patients being seen for conditions such as “flu like symptoms” would be given a lower acuity such as a green three or a four. In the emergency department at LGH there are two different areas of care. These areas include main side which is generally for patients with an acuity of yellow three or higher. The other side of the emergency department is the “fast care” section which is for lower acuity patients (green three, four, or five) who will not require as extensive treatment. By sorting patients based on acuity this allows us as providers to room the higher acuity patients and see them first ensuring they receive the care they need when they need it. As noted from the readings, “EDs are high-risk, high-stress environments. When capacity is exceeded, there are heightened opportunities for error (McHugh, et al. 2012). By having two sections in our emergency department this allows us to move patients along and see lower acuity patients consistently without having to wait for a main side bed. Most of the fast care patients only need simple things such as a small laceration repair or imaging to rule out a broken bone. Main side patients usually receive a more extensive workup including labs, imaging, and IV medications. By having both a main side and fast care side this goes hand in hand with quality improvement because it allows more patients to be seen in a timely manner reducing wait times and door to room times.