Make your most common ED nursing tasks mobile
Patients and nurses are happier with mobile systems
It's a common source of frustration in many EDs: leaving patients in the waiting room until a "specialty" room is available, or placing the patient in a room that doesn't have the right equipment, which delays care. That's why many EDs are investing in mobile workstations on laptops or wheeled carts.
At Seattle-based Swedish Medical Center's ED, wheeled equipment carts are used, which allows rooms to serve a variety of purposes, says Judy Street, RN, former ED nurse manager. The carts, manufactured by Armstrong Medical Industries, cost $600 to $1,200 per cart. With the carts, you bring the supplies to the patient, thus creating flexible space, she says. "Flow is improved, as you do not have patients waiting for the 'special' room any longer," Street says. "Rooms now can be used for any patient type with the exception of the most critical patients, who would require maximum space and equipment."
Similarly, mobile registration carts (also manufactured by Armstrong, at a cost of $1,000 to $1,500 per cart) allow ED nurses at Swedish to move patients directly to a room instead of being held in a waiting room for registration. "Triage can be done by the 'back nurse or primary nurse' when beds are available, thus freeing up the triage nurse when there is a line of patients," says Street.
The ED's computer system allows for a quick registration so the patient is entered into the system, allowing the nurse or physician to initiate orders. "The idea is, if you can provide faster service to the patient, and shorter wait and treatment room times, you will improve patient satisfaction and volumes — and revenue as well," says Street.
Patients more satisfied
It wasn't easy for ED nurses to become accustomed to the "mobile" way of performing tasks, says Street. "It does require a new approach psychologically for nurses, physicians, and clerical staff. It is not always an easy transition," she says.
The most frequent complaint from ED nurses was that if a patient is placed in a room and a nurse is not immediately available, the nurse assigned to that room or section feels an urgency to get to the patient and worries that they will not be able to do so in a timely and safe manner, says Street.
Street reminded the ED nurses that a patient in a waiting room has no call light and the triage nurse is responsible for all the patients, which is much more of a safety issue than if the patient is in a treatment area. "If patients are not in rooms, 'out of sight, out of mind' can occur, especially during changes in shift," she says.
Gradually, ED nurses began to see that patients were more satisfied with the mobile processes. "It also improved their organizational skills, required tighter protocols for initiating treatment or tests, and smoothed out the flow vs. the usual 'the bus unloaded' experience," says Street.
Wheeled workstations save time
At Indiana University Hospital's ED, six computers on wheels, manufactured by Stinger Medical, were implemented at a total cost of about $5,000. The nurses call them WOWs (workstations on wheels). "The nurses seem to like them. They allow them to stand and do quick charting and also to look up stuff for physicians in the hallways, which is where they tend to use them," says India Owens, RN, BSN, the ED's manager of clinical operations.
The WOWs are set up so they can be lowered to accommodate nurses wearing bifocals as well as being able to be raised to eye level for nurses who are not, says Owens. "This was one of the pitfalls that nurses on the inpatient units complained about — that the workstations are too high and difficult to use if you are a bifocal wearer," she explains.
The WOWs must be plugged in most of the time, because the device shuts off if left unplugged; plugging it back in allows it to recharge. "Brief periods off power are OK, but very brief, so we needed to make sure there were ample outlets to plug them into before going live," Owens says. "During power outages with no computer access, we use paper forms that mimic the electronic ones."
When caring for critically ill patients, nurses use a wheeled station on one side of the bed along with a wall-mounted workstation on the other side of the bed, says Owens. "This allows the physician to view lab values and a nurse to enter orders live at the bedside while another nurse charts," she says.
For more information on mobile workstations, contact:
- India Owens, RN, BSN, Manager, Clinical Operations, Emergency Department, Indiana University Hospital, 550 N. University Blvd., Indianapolis, IN 46202. Phone: (317) 278-8306. E-mail: IOwens@clarian.org.
- "Computers on wheels" are available using laptop computers wirelessly connected to various patient information databases, at a cost of about $3,000, including cart and computer. For more information, contact: Stinger Medical, 1152 Park Ave., Murfreesboro, TN 37129. Phone: (888) 909-8930 or (615) 896-1652. Fax: (615) 896-8906. E-mail: firstname.lastname@example.org. Web: www.stingermedical.com.
- A variety of mobile equipment and registration carts are available from Armstrong Medical Industries. For more information, contact Armstrong at 575 Knightsbridge Parkway, P.O. Box 700 Lincolnshire, IL 60069-0700. Phone: (800) 323-4220 or (847) 913-0101. Fax: (847) 913-0138. E-mail: email@example.com. Web: www.armstrongmedical.com.