Quality Improvement: Implementing Nurse Standard Work in Emergency Department Fast-Track Area to Reduce Patient Length of Stay.
Dorothy Williams, Lawrence D Fredendall, Gregory Hair and 5 others
PMID 36075769WHAT IT FOUND
Fast-track nurse standard work, supply, patient pulling, registration, order batching, and audit changes were followed by lower average length of stay: 200.2 minutes to 150 minutes.
Key findings
01Average length of stay in fast-track patients fell from an initial 200.2-minute centerline to 150 minutes and remained below the 162-minute target until the unit was converted to COVID-19 care.
02Left without being seen decreased below the 2% target and stayed there through March 2020.
03The registered nurse and nurse specialty technician workloads were reduced to 799 seconds and 802 seconds, 10 and 7 seconds below their 809-second takt targets.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a before-and-after quality improvement study at one emergency department, with no control group, so other changes over time could explain the improvement. Multiple workflow changes were introduced together, including supply storage, patient pulling, registration timing, and order batching, so the effect of nurse standard work alone cannot be separated. The study measured length of stay and left-without-being-seen, not patient satisfaction or clinical outcomes. The fast-track area was closed for COVID-19 in March 2020, so maintenance beyond that point was not observed. Task observations were time limited, and the specific task assignments may not fit other units.
Declared interests
The authors report no conflicts of interest. The study was exempt from institutional review board review because it did not involve human subjects research. No funding source is stated.
The easy way to misread this
Do not conclude that nurse standard work by itself caused the shorter stays. Multiple process changes were made at once, including supply storage, patient pulling, registration timing, and order batching, and the study had no control group.